Trimethoprim–sulfamethoxazole-induced refractory hypoglycaemia successfully treated with octreotide

Abstract

Trimethoprim–sulfamethoxazole (TMP–SMX) is a commonly prescribed antimicrobial agent for a wide variety of infections. It is generally well tolerated in a majority of patients; however, serious adverse effects have been described with its usage. Hypoglycaemia is an exceedingly rare but potentially life-threatening side effect of this antimicrobial agent due to its sulfonylurea-like effect. We describe a case of symptomatic, refractory hypoglycaemia secondary to TMP–SMX in a patient being treated for Stenotrophomonas maltophilia bacteraemia, which required treatment with 10 hours of intravenous dextrose (including several 50% dextrose boluses), as well as intramuscular glucagon and octreotide. We reviewed previous case reports described in the literature of TMP–SMX-induced hypoglycaemia, in which renal insufficiency was noted to be a common predisposing risk factor in an overwhelming majority of cases. In refractory cases of TMP–SMX-induced hypoglycaemia, intravenous octeotride may be considered for treatment.

Severe Cotrimoxazole-induced Hypoglycemia in a Patient with Pneumocystis jirovecii Pneumonia: A Case Report

“…3,8 Drugs such as glucagon, octreotide, and diazoxide have also been used in patients with refractory hypoglycemia. 16,17 Further continuation of cotrimoxazole at a reduced dose has also been possible in a few patients. 5 Hypoglycemia can present with a broad range of severity, ranging from mild hypoglycemia with only a headache to severe hypoglycemia causing loss of consciousness and seizures.…”

Dose Dependent Effect of Sulfamethoxazole on Inhibiting KATP Channel of Mouse Pancreatic β Cell

“…Also, renal insufficiency such as renal failure or renal transplant is a predisposing risk factor for developing hypoglycemia when using SMX. 13,25,26 SMX is excreted from the kidney and its half-life is considered as 8-15 hours and the Food and Drug Administration discourages its use for patients with impaired kidney function. 27,28 These clinical reports indicate that patients who may have a background that has higher SMX concentration are prone to experience hypoglycemia.…”