Article Text

Download PDFPDF
Unexpected outcome (positive or negative) including adverse drug reactions
Hypoglycaemia associated with co-trimoxazole use in a 56-year-old Caucasian woman with renal impairment
  1. Donall G Forde,
  2. Jody Aberdein,
  3. Anne Tunbridge,
  4. Ben Stone
  1. Department of Infection and Tropical Medicine, Sheffield Teaching Hospital, Sheffield, UK
  1. Correspondence to Dr Donall G Forde, donallforde{at}


Here we present a case of refractory hypoglycaemia associated with use of the antibiotic trimethoprim-sulfamethoxazole (TMP-SMX). This was used to treat Pneumocystis jirovecii pneumonia (PCP) infection. The patient had significant pre-existing renal impairment with a kidney transplant in situ. Refractory hypoglycaemia occurred 5 days after starting the antibiotic and persisted for 36 h after its cessation. SMX contains the same sulphanilamide structural group as the oral hypoglycaemic agents called sulphonureas. SMX could therefore act as an insulin secretagogue. The inappropriately raised insulin and c-peptide levels seen in our patient support this theory. The 5-day asymptomatic period would allow sufficient time for the drug to accumulate and the extended period seen after its cessation would be seen in a dose-dependent side effect. Following 3 days of observation and continuous glycaemic support on the High Dependency Unit she was discharged back to the ward, with no further occurrence of hypoglycaemia.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.