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Drug-induced acute pancreatitis (AP) associated with tigecycline (TGC) is considered a rare complication (incidence between 1, and 1%). In this paper, we report five cases of AP occurring after the administration of TGC in septic patients hospitalized in intensive burn care in Tunisia over 9 years. The diagnosis of AP was based on clinical and/or biological signs. Among 303 cases treated with TGC, AP occurred with an incidence of 1.65%. The mean age was 28±6 years. Only one patient had a history of chronic alcoholism. The prescribed dose was 200 mg as a loading dose, followed by 100 mg twice a day. The time to onset of symptoms after initiation of TGC was 5.4 days [2-7]. PA was suspected due to abdominal pain associated with nausea and vomiting (n=2), occlusive syndrome (n=1) and fortuitously increased pancreatic enzymes in 2 patients under mechanical ventilation. The mean lipase level at diagnosis was 447 IU ± 135 IU (4.5 to 10 times the normal). All the aetiologies of AP were ruled out, including gallstones, hypercalcemia, hypertriglyceridemia, trauma and infections. The mean time to symptom resolution after stopping TGC was 4±2 days [5-7] and to the normalization of pancreatic enzymes it was 9 days [2-20 days]. In conclusion, clinical and biological monitoring was necessary in patients treated with TGC in order to avoid severe forms, especially in at-risk patients. [ABSTRACT FROM AUTHOR]

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Summary: Digestive abnormalities contribute significantly to the morbidity in cystic fibrosis as well as to the mortality, through their relations with the pulmonary part of the disease. Physiopathological consequences of the CFTR misfunction at different levels of the digestive tract (biliary and pancreatic secretions, digestionabsorption mechanisms) are not well understood. Even if pancreatic insufficiency is the most evident and critical problem, it is not the only one. That is the reason why pancreatic enzyme replacement therapy does not resolve all the digestive symptoms. Research is needed for a better understanding of digestive abnormalities in cystic fibrosis and their treatment. [Copyright &y& Elsevier]