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Slow replenishment of carnitine deficiency after cessation of long-term treatment with pivaloyl-containing antibiotics |
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| Authors: | Quy N Diep Thomas Bøhmer Jan I Holme Ansgar Torvik Olav T Storrøsten Christian W Loennecken Per Monstad and Egil Jellum |
| Institution: | (1) Medical Department, Aker University Hospital, 0514 Oslo, Norway;(2) Grenseveien 8, 0571 Oslo, Norway;(3) Department of Pathology, Ullevål University Hospital, 0450 Oslo, Norway;(4) Department of Pediatrics, Aker University Hospital, Oslo, Norway;(5) Ring Medisinsk a.s., Sørkedalsv. 33, 0369 Oslo, Norway;(6) Haugesund Hospital, 5500 Haugesund, Norway;(7) Institute of Clinical Biochemistry, Rikshospitalet, 0027 Oslo, Norway |
| Abstract: | Long-term treatment with pivampicillin and pivmecillinam for 6–24 months in five adults and one child reduced the total serum carnitine concentration to 3.7–14  mol/l (reference value: 25–66 mol/l). Muscle carnitine was reduced to 0.3–0.7mol/g wet weight (reference value: 3–5mol/g) in two cases. All patients had muscle symptoms with weakness, asthenia and pains. One showed signs of carnitine depletion in the liver with increased secretion of dicarboxylic acids (C6, C8, C10) in urine and limited ketone body formation during prolonged fasting. Serum carnitine increased slowly after cessation of therapy and reached normal concentrations after 6–12 months. All symptoms caused by carnitine depletion disappeared. This was achieved on a normal diet without carnitine supplementation. |
| Keywords: | Carnitine/deficiency Dicarboxylic acids Diet Pivampicillin Pivmecillinam |
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