Probable Trimethoprim/Sulfamethoxazole–Induced Higher-Level Gait Disorder and Nocturnal Delirium in an Elderly Man

Abstract

At time of writing, this was the first reported case of HLGD associated with TMP/SMX. Clinicians should consider this adverse reaction as a potential cause of HLGD, especially in the elderly and those with malnutrition and hepatic or renal dysfunction.

Considerations when prescribing trimethoprim-sulfamethoxazole

“…Numerous instances of aseptic meningitis (involving high doses of trimethoprim alone or trimethoprimsulfamethoxazole) have been reported, many of them involving patients with pre-existing autoim- Older age, previous neurologic injury, infection, metabolic disturbances 5,6 Relatively uncommon…”

“…5,6 In general, neurologic symptoms occur within days of continuous treatment and resolve following discontinuation of trimethoprim-sulfamethoxazole.…”

Suspect novel adverse drug reactions to trimethoprim‐sulphonamide combinations in horses: A case series

“…1998; Patterson and Couchenour 1999). A higher level gait disorder (gait apraxia), suspected to be an ADR to a TMP‐sulphonamide combination has also been described (Dakin 2009).…”

“…In human medicine, the Naranjo ADR probability scale is widely used to classify a drug as a definite, probable, possible or doubtful cause of the suspected ADR (Naranjo et al . 1981; Dakin 2009). The scale applies a series of 10 questions, each answered as ‘yes,’‘no’ or ‘do not know,’ when assessing a suspected ADR.…”

“…Psychoses during therapy with TMP-sulphonamide combinations have manifested as visual hallucinations and extreme agitation. In no case was another cause for the clinical signs determined, despite extensive investigation (haematological and serum biochemical analysis, cerebrospinal fluid cytology, computed tomography and magnetic resonance imaging) and all patients recovered after withdrawal of medication (Mermel et al 1986;McCue and Zandt 1991;Gregor et al 1993;Salkind 2000;Saidinejad et al 2005;Weis et al 2006;Dakin 2009).…”