Published online August 27, 2007
PEDIATRICS Vol. 120 No. 3 September 2007, pp. e739-e741 (doi:10.1542/peds.2007-0339)
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EXPERIENCE & REASON

Carnitine-Associated Encephalopathy Caused by Long-term Treatment With an Antibiotic Containing Pivalic Acid

Yasuko Makino, MDa, Tokio Sugiura, MD, PhDa, Tetsuya Ito, MD, PhDb, Naruji Sugiyama, MD, PhDc and Norihisa Koyama, MD, PhDa

a Department of Pediatrics, Toyohashi Municipal Hospital, Aichi, Japan
b Department of Pediatrics, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
c Department of Pediatrics, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan

ABSTRACT

An 18-month-old boy was treated with an antibiotic containing pivalic acid for 6 months for intractable otitis media and then developed repeated convulsions and loss of consciousness. Laboratory data showed hypoglycemia and hypocarnitinemia. Intravenous administration of glucose was ineffective against the seizures and loss of consciousness. However, the patient regained consciousness and recovered soon after intravenous infusion of carnitine. To our knowledge, intravenous carnitine administration that contributed to marked improvements in neurologic deficit caused by administration of an antibiotic containing pivalic acid has not been reported previously. These findings indicate that long-term use of such antibiotics should be avoided.

Key Words: carnitine • encephalopathy • hypoglycemia • otitis media • pivalic acid • antibiotics

Accepted Jun 8, 2007.


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