Analysis of clinical features of metronidazole-induced acute pancreatitis based on literature cases
10.3760/cma.j.cn114015-20191230-01099
- VernacularTitle:基于文献病例的甲硝唑致急性胰腺炎临床特征分析
- Author:
Jun CHENG
1
;
Guanjun ZHANG
1
;
Yixuan HAN
1
Author Information
1. 安徽省蚌埠市第三人民医院药学部，蚌埠 233000
- Publication Type:Journal Article
- Keywords:
Pancreatitis;
Metronidazole;
Disease attributes
- From:
Adverse Drug Reactions Journal
2020;22(10):568-572
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the clinical features of metronidazole-related acute pancreatitis.Methods:Literature included in PubMed database up to September 2019 were searched and cases with a clear causal relationship between metronidazole and acute pancreatitis and relatively complete clinical data were collected. The following information of patients including nationality, gender, age, primary diseases, comorbidity, metronidazole medication, combined medication, occurrence of acute pancreatitis (time from medication to the onset of acute pancreatitis, symptoms, major laboratory tests results, pancreatic imaging findings, and etc.), and clinical treatments and outcomes was extracted. The collected data was analyzed by descriptive statistical method.Results:A total of 12 patients were entered, including 8 from the Unite States, 4 from Greece, France, Ireland, and Turkey, respectively; 3 were males and 9 were females, aged from 22 to 63 years. The primary diseases in 5 patients were vaginitis and in 7 patients were Crohn disease, aspiration pneumonia, ulcerative colitis, pseudomembranous colitis, periodontal abscess, and ulcerative colitis combined with Clostridium difficile colitis, and Clostridium difficile colitis, respectively; 1 of them were accompanied by history of peptic ulcer. A total of 24 times of metronidazole-related acute pancreatitis occurred in 12 patients (1, 2, 3, and 4 times occurred in 4, 5, 2, and 1 patients, respectively); 23 of them occurred in oral medication and 1 in intravenous medication; 16 cases occurred when metronidazole was used alone and 8 when metronidazole was in combination with other drugs. Time from the first application of metronidazole to the onset of acute pancreatitis was (3.9±2.8) days in 12 patients, time from reapplying metronidazole to recurrence of acute pancreatitis in 8 patients was (3.0±2.5) days, and the range of occurrence time both were 12 hours to 8 days after medication. The clinical symptoms, laboratory tests, and imaging findings of metronidazole-related acute pancreatitis were similar to those caused by other drugs. All the 24 times of acute pancreatitis had clinical symptoms, including 24 times of abdominal pain, 21 times of nausea, and 20 times of vomiting. Metronidazole was discontinued after the diagnosis of acute pancreatitis. Treatment measures were described in 17 times of acute pancreatitis, including symptomatic and supportive treatments such as fasting, analgesia, and antiemesis in 11 times. All patients recovered after 2-22 days of metronidazole withdrawal. Conclusions:Metronidazole-related acute pancreatitis usually occurred within 8 days of medication and it mainly manifested as abdominal pain. Prodromal symptoms such as nausea and vomiting might occur in some patients. Early diagnosis and timely discontinuation of the drug might be helpful to a better prognosis in general.
