Toxic-metabolic encephalopathy induced by metronidazole and disulfiram: classics never die.

Autores de IIS La Fe

• Octavio Antonio Ballesta López

  Autor

• Asunción Albert Marí

  Autor

• Maria Jose Ruiz Caldes

  Autor

• Javier García Pellicer

  Autor

• José Luis Poveda Andrés

  Autor

Participantes ajenos a IIS La Fe

• Chovi-Trull, Maria
• Navarro Buendia, Gema Amparo
• Sivera-Mascaro, Rafael

Grupos

• Grupo de Investigación de Farmacia

Abstract

A 53-year-old male with recovering alcohol dependency, diagnosed with bipolar disorder and recurrent episodes of diverticulitis, came to the emergency department with disorientation and confusion after 3days of treatment with metronidazole 250mg/12hours and ciprofloxacin 500mg/12hours for acute diverticulitis. In the hospital emergency department, he presented moments of agitation, fluctuations of attitude, increased basal tremor, with rhythmic movement of the left arm and leg, as well as generalised rigidity with an episode of tonic-clonic seizure of 1.5-2min duration. After performing different diagnostic tests, significant brain findings were ruled out. The pharmacy department recommended the discontinuation of one of the two drugs. As a result, the on-call doctor adjusted the patient's treatment: disulfiram and previous antibiotic therapy (metronidazole and ciprofloxacin) were discontinued, and amoxicillin/clavulanic acid 2g/8hour was prescribed instead. The patient progressed well and fully recovered.

© European Association of Hospital Pharmacists 2024. No commercial re-use. See rights and permissions. Published by BMJ.

Keywords

• DRUG-RELATED SIDE EFFECTS AND ADVERSE REACTIONS; EMERGENCY MEDICINE; MEDICAL ERRORS; NEUROLOGY; PHARMACY SERVICE, HOSPITAL