SLOW REPLENISHMENT OF CARNITINE DEFICIENCY AFTER CESSATION OF LONG-TERM TREATMENT WITH PIVALOYL-CONTAINING ANTIBIOTICS

Long-term treatment with pivampicillin and pivmecillinam for 6-24 mont hs in five adults and one child reduced the total serum carnitine conc entration to 3.7-14 mumol/l (reference value: 25-66 mumol/l). Muscle c arnitine was reduced to 0.3-0.7 mumol/g wet weight (reference value: 3 -5 mumol/g) in two cases. All, patients had muscle symptoms with weakn ess, asthenia and pains. One showed signs of carnitine depletion in th e liver with increased secretion of dicarboxylic acids (C6, C8, C10) i n urine and limited ketone body formation during prolonged fasting. Se rum carnitine increased slowly after cessation of therapy and reached normal concentrations after 6-12 months. All symptoms caused by carnit ine depletion disappeared. This was achieved on a normal diet without carnitine supplementation.