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Stefanos SS, Davis L, Panwala A, Gelfand MS, Animalu CN, Cutshall BT. Prolonged course of eravacycline leading to acute pancreatitis. Am J Med Sci 2023; 366:464-467. [PMID: 37716601 DOI: 10.1016/j.amjms.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 02/08/2023] [Accepted: 09/11/2023] [Indexed: 09/18/2023]
Abstract
Eravacycline is the newest member of the broad-spectrum class of tetracycline antimicrobials. Pancreatitis has been previously associated with the tetracycline class of antibiotics, but, to our knowledge, we believe that this is the first reported case of eravacycline-induced pancreatitis. We describe a 46-year-old male who received eravacycline for treatment of a perirectal abscess. While the patient had slightly elevated lipase levels at baseline post-cardiopulmonary arrest, he developed abdominal pain and a further increase in lipase levels following 10 days of eravacycline, consistent with pancreatitis. Based on the Naranjo adverse drug reaction probability scale, eravacycline was the probable etiology of acute pancreatitis given improvement immediately after discontinuation. Clinicians should be aware of this potential adverse effect of eravacycline and should not initiate eravacycline in those with risk factors for acute pancreatic injury. However, acute pancreatitis should be suspected in all patients complaining of symptoms followed by immediate discontinuation of eravacycline.
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Affiliation(s)
- Sylvia S Stefanos
- Department of Pharmacy, Methodist University Hospital, Memphis, TN, USA.
| | - Lyndsey Davis
- Department of Pharmacy, Methodist University Hospital, Memphis, TN, USA
| | - Amruta Panwala
- Department of Internal Medicine, Methodist University Hospital, Memphis, TN, USA
| | - Michael S Gelfand
- Department of Infectious Diseases, Methodist University Hospital, Memphis, TN, USA; Division of Infectious Diseases - University of Tennessee Health Science Center, Memphis, TN, USA
| | - Chinelo N Animalu
- Department of Infectious Diseases, Methodist University Hospital, Memphis, TN, USA; Division of Infectious Diseases - University of Tennessee Health Science Center, Memphis, TN, USA
| | - B Tate Cutshall
- Department of Pharmacy, Methodist University Hospital, Memphis, TN, USA
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Barbulescu A, Oskarsson V, Lindblad M, Ljung R, Brooke HL. Oral metronidazole use and risk of acute pancreatitis: a population-based case-control study. Clin Epidemiol 2018; 10:1573-1581. [PMID: 30464637 PMCID: PMC6208546 DOI: 10.2147/clep.s159702] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective Oral metronidazole used in combined regimens for Helicobacter pylori eradication has been associated with an increased risk of acute pancreatitis; however, it is less clear whether a similar association exists for single-regimen metronidazole. We, therefore, examined the association of single and combined regimens of oral metronidazole with risk of acute pancreatitis. Methods In this population-based case-control study, all individuals in Sweden (aged 40-84 years) hospitalized with acute pancreatitis between January 2006 and December 2008 were identified from a national hospital register (n=5,996). Controls, matched for calendar year, age, and sex, were randomly sampled from a national population register (n=60,681). Data on oral metronidazole and covariates were extracted from national health and prescription registers. Odds ratios (ORs) of acute pancreatitis, according to timing of the latest metronidazole prescription before hospitalization, were estimated using logistic regression models. Confounding by indication was examined by contrasting the main results with the association when amoxicillin was used as exposure. The robustness of results was examined by calculating incidence rate ratios using a self-controlled case series approach. Results After adjustment for potential confounders, there was a substantially increased risk of acute pancreatitis within 30 days of oral metronidazole exposure, both for single (OR: 4.06; 95% confidence interval [CI]: 1.90-8.64) and combined (OR: 11.80; 95% CI: 6.86-20.28) regimens, compared to nonexposure. In contrast, the adjusted OR was 1.79 (95% CI: 1.25-2.54) for current use of amoxicillin compared to nonexposure. These results were supported by the self-controlled cases series analysis (incidence rate ratio: 3.30; 95% CI: 2.69-4.06, for single and combined regimens of oral metronidazole pooled). There was no strong association between oral metronidazole and acute pancreatitis more than 30 days after exposure. Conclusion There was an increased risk of acute pancreatitis within 30 days of exposure to single and combined regimens of oral metronidazole. While reverse causality and confounding by indication cannot be entirely excluded, they are unlikely to fully explain the association. These results warrant an increased awareness among physicians.
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Affiliation(s)
- Andrei Barbulescu
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden,
| | - Viktor Oskarsson
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lindblad
- Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Rickard Ljung
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden,
| | - Hannah L Brooke
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden,
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Bexelius TS, Ljung R, Mattsson F, Lu Y, Lindblad M. Angiotensin II receptor blockers and risk of acute pancreatitis - a population based case-control study in Sweden. BMC Gastroenterol 2017; 17:36. [PMID: 28270103 PMCID: PMC5341438 DOI: 10.1186/s12876-017-0595-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 03/01/2017] [Indexed: 01/17/2023] Open
Abstract
Background Acute pancreatitis is a potentially lethal disease, with a rising incidence in the Western world. Yet, no pharmacological prevention or specific treatment for acute pancreatitis exists. Also, the connection with severity of acute pancreatitis is unknown. Experimental and epidemiological research suggests a protective effect of angiotensin II receptor blockers. Methods During 2006 to 2008, we performed a nationwide case–control study on Swedish residents aged 40–84 years. First-time cases with acute pancreatitis were identified in the National Patient Register and data on dispensed prescriptions was retrieved from the Prescribed Drug Register. Controls were randomly selected from the general population in Sweden frequency-matched on sex, age, and calendar year. To estimate relative risk of acute pancreatitis, by degree of severity, among users of angiotensin II receptor blockers, as compared to non-users, we used multivariable logistic regression analysis to calculate odds ratios (OR) with 95% confidence interval (CI). Results Among 6,161 cases of acute pancreatitis and 61,637 controls, current use of angiotensin II receptor blockers was followed by a decreased risk of acute pancreatitis, compared to non-users, adjusted OR 0 · 77 (95% CI 0 · 69–0 · 86). No protective association, but an increased risk was found for users of angiotensin-converting enzyme inhibitors (adjusted OR 1 · 11, 95% CI: 1 · 01–1 · 21), analysed for comparison reasons. There was a significant decreased risk associated with both severe acute pancreatitis, (OR 0 · 71 (0 · 59–0 · 85), and mild acute pancreatitis; adjusted OR 0 · 81 (0 · 70–0 · 94). Conclusion This population-based case–control study indicates that use of angiotensin II receptor blockers might be associated with a lesser risk of acute pancreatitis, and that the protective association was significant among cases of both severe and mild acute pancreatitis. Electronic supplementary material The online version of this article (doi:10.1186/s12876-017-0595-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tomas S Bexelius
- Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. .,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, S-171 77, Stockholm, Sweden.
| | - Rickard Ljung
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Mattsson
- Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Yunxia Lu
- Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Program in Public Health, University of California, Irvine, CA, USA
| | - Mats Lindblad
- Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of CLINTEC, Karolinska Institutet, Stockholm, Sweden
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Razavi D, Lindblad M, Bexelius T, Oskarsson V, Sadr-Azodi O, Ljung R. Polypharmacy and risk of acute pancreatitis. Pharmacoepidemiol Drug Saf 2016; 25:1337-1341. [DOI: 10.1002/pds.4109] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/18/2016] [Accepted: 08/25/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Dan Razavi
- Division of Surgery, Department of Clinical Science, Intervention, and Technology; Karolinska Institutet; Stockholm Sweden
| | - Mats Lindblad
- Division of Surgery, Department of Clinical Science, Intervention, and Technology; Karolinska Institutet; Stockholm Sweden
- Section of Upper Gastrointestinal Surgery, Centre of Gastrointestinal Disease; Karolinska University Hospital; Stockholm Sweden
| | - Tomas Bexelius
- Department of Clinical Science and Education; Södersjukhuset; Stockholm Sweden
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Sweden
| | - Viktor Oskarsson
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
| | - Omid Sadr-Azodi
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
| | - Rickard Ljung
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
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Ludvigsson JF, Almqvist C, Bonamy AKE, Ljung R, Michaëlsson K, Neovius M, Stephansson O, Ye W. Registers of the Swedish total population and their use in medical research. Eur J Epidemiol 2016; 31:125-36. [PMID: 26769609 DOI: 10.1007/s10654-016-0117-y] [Citation(s) in RCA: 1014] [Impact Index Per Article: 126.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 01/08/2016] [Indexed: 12/22/2022]
Abstract
The primary aim of the Swedish national population registration system is to obtain data that (1) reflect the composition, relationship and identities of the Swedish population and (2) can be used as the basis for correct decisions and measures by government and other regulatory authorities. For this purpose, Sweden has established two population registers: (1) The Population Register, maintained by the Swedish National Tax Agency ("Folkbokföringsregistret"); and (2) The Total Population Register (TPR) maintained by the government agency Statistics Sweden ("Registret över totalbefolkningen"). The registers contain data on life events including birth, death, name change, marital status, family relationships and migration within Sweden as well as to and from other countries. Updates are transmitted daily from the Tax Agency to the TPR. In this paper we describe the two population registers and analyse their strengths and weaknesses. Virtually 100 % of births and deaths, 95 % of immigrations and 91 % of emigrations are reported to the Population Registers within 30 days and with a higher proportion over time. The over-coverage of the TPR, which is primarily due to underreported emigration data, has been estimated at up to 0.5 % of the Swedish population. Through the personal identity number, assigned to all residents staying at least 1 year in Sweden, data from the TPR can be used for medical research purposes, including family design studies since each individual can be linked to his or her parents, siblings and offspring. The TPR also allows for identification of general population controls, participants in cohort studies, as well as calculation of follow-up time.
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Affiliation(s)
- Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177, Stockholm, Sweden.
- Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Anna-Karin Edstedt Bonamy
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet and Hospital, Stockholm, Sweden
| | - Rickard Ljung
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karl Michaëlsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Martin Neovius
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Olof Stephansson
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet and Hospital, Stockholm, Sweden
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177, Stockholm, Sweden
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Gadolinium induced recurrent acute pancreatitis. Pancreatology 2012; 13:88-9. [PMID: 23395575 DOI: 10.1016/j.pan.2012.12.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 11/22/2012] [Accepted: 12/03/2012] [Indexed: 12/11/2022]
Abstract
Acute pancreatitis is a sudden swelling and inflammation of the pancreas. The two most common causes are alcohol use and biliary stones. Drug-induced acute pancreatitis are rare (1.4-2%). In this present study, we present a case of recurrent acute pancreatitis induced by a specific magnetic-resonance-imaging (MRI) contrast agent called gadobenate dimeglumine.
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