PMID- 19109207
OWN - NLM
STAT- MEDLINE
DCOM- 20100104
LR  - 20151119
IS  - 1542-6270 (Electronic)
IS  - 1060-0280 (Linking)
VI  - 43
IP  - 1
DP  - 2009 Jan
TI  - Probable trimethoprim/sulfamethoxazole-induced higher-level gait disorder and 
      nocturnal delirium in an elderly man.
PG  - 129-33
LID - 10.1345/aph.1L295 [doi]
AB  - OBJECTIVE: To report a case of probable trimethoprim/sulfamethoxazole 
      (TMP/SMX)-induced higher-level gait disorder (HLGD) and nocturnal delirium in an 
      elderly patient on high-dose oral therapy. CASE SUMMARY: An 82-year-old man with 
      a recent history of depression became comatose following an overdose of 
      escitalopram and oxazepam. He was admitted, ventilated for 7 days in the 
      intensive care unit, and treated with piperacillin/tazobactam and cefepime for 
      aspiration pneumonia. Following discharge to a medical ward, respiratory symptoms 
      persisted and imaging confirmed pulmonary abscesses. Stenotrophomonas maltophilia 
      was isolated from sputum and, on day 15, TMP/SMX 800 mg/160 mg 1 tablet every 12 
      hours was initiated. On day 35, the dose was increased to 800 mg/160 mg 2 tablets 
      every 12 hours. By day 37, the patient was unsteady when attempting to stand. 
      From day 40, he was noted to have features of HLGD with gait ignition failure, 
      poor balance, and frequent falls. His other medications at this time were 
      thiamine 100 mg daily, multivitamin 1 tablet daily, omeprazole 20 mg every 12 
      hours, and modified-release venlafaxine 150 mg daily. Investigation did not 
      reveal any cause for his acute gait disturbance. TMP/SMX was stopped on day 48 
      and, by day 51, the patient's gait had returned to normal. DISCUSSION: 
      Neuropsychiatric adverse reactions with TMP/SMX have been infrequently reported. 
      The Naranjo probability scale indicated that TMP/SMX was the probable cause of 
      HLGD in this patient. CONCLUSIONS: At time of writing, this was the first 
      reported case of HLGD associated with TMP/SMX. Clinicians should consider this 
      adverse reaction as a potential cause of HLGD, especially in the elderly and 
      those with malnutrition and hepatic or renal dysfunction.
FAU - Dakin, Lucy E
AU  - Dakin LE
AD  - Department of Geriatric Medicine, The Prince Charles Hospital, Chermside, 
      Queensland 4032, Australia. Lucy_Dakin@health.qld.gov.au
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20081223
PL  - United States
TA  - Ann Pharmacother
JT  - The Annals of pharmacotherapy
JID - 9203131
RN  - 8064-90-2 (Trimethoprim, Sulfamethoxazole Drug Combination)
SB  - IM
MH  - Aged, 80 and over
MH  - Delirium/*chemically induced/complications/diagnosis
MH  - Dyssomnias/*chemically induced/complications/diagnosis
MH  - Gait Disorders, Neurologic/*chemically induced/complications/diagnosis
MH  - Humans
MH  - Male
MH  - Trimethoprim, Sulfamethoxazole Drug Combination/*adverse effects
EDAT- 2008/12/26 09:00
MHDA- 2010/01/05 06:00
CRDT- 2008/12/26 09:00
PHST- 2008/12/26 09:00 [entrez]
PHST- 2008/12/26 09:00 [pubmed]
PHST- 2010/01/05 06:00 [medline]
AID - aph.1L295 [pii]
AID - 10.1345/aph.1L295 [doi]
PST - ppublish
SO  - Ann Pharmacother. 2009 Jan;43(1):129-33. doi: 10.1345/aph.1L295. Epub 2008 Dec 
      23.