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Consequently, prolonged use of pivalic acid-containing antibiotics, including pivampicillin, pivmecillinam, pivcephalexin, and cefditoren pivoxil (Spectracef), can lead to secondary L-carnitine deficiency (135)

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Liquid chromatography and tandem mass spectrometry (LC-MS/MS) analyses of TrxR1 and aspirin-acetylated TrxR1 were performed at the Biological Mass Spectrometry Laboratory at The University of Western Ontario