A Comparison of Adverse Drug Reactions Between High- and Standard- Dose Trimethoprim-Sulfamethoxazole in the Ambulatory Setting

Abstract

ADRs such as hyperkalemia are more likely to be associated with the use of high-dose TMP-SMX in the ambulatory setting. Clinicians should use caution when initiating high-dose TMP-SMX and consider laboratory monitoring in patients of advanced age or those receiving concomitant ACE inhibitor therapy.

Isolated Nocardiosis, an Unrecognized Primary Immunodeficiency?

“…It was thought that all Nocardia strains are susceptible to these drugs (334); however, this is not the case, and susceptibility testing should be performed before starting the treatment (335), given that resistance is specie specific (336,337). Besides, some people are allergic to TMP-SMX, which is sometimes observed after treatment starts with the additional risk that this brings for the patient (338). The standards dictate that for cutaneous disease, TMP-SMX should be administered for 1-3 months, for pulmonary disease during 6-12 months, and for disseminated, especially CNS infection, it should be of 12 months sometimes, even more, depending on the progress of the disease (339).…”

A pilot study of safety of sulfamethoxazole, trimethoprim and guaifenesin in pediatric and adult patients with acute bronchitis

“…In this exploratory study, rates of adverse event was higher than reported previously to the combination of sulfamethoxazole and trimethoprim [9]; however, these results should be taken carefully interpreted because this work is only designed to obtain a sample size for a further study.…”

“…The result of the calculation is 48.4 patients. The premise of a probability adverse-drug reaction of 6% was obtained in a previous article by Nguyen et al [9], describing an adverse drug reaction rate of 9% in a cohort of patients treated with high and standard doses of the combination of sulfamethoxazole and trimethoprim where the frequency of adverse reactions for standard dose was 5.1%.…”

Evaluation of treatment outcomes for Stenotrophomonas maltophilia bacteraemia

“…Newer fluoroquinolones, minocycline or tigecycline might be future alternatives to combat emerging TMP/ SMX resistance; however, the selection of resistant S. maltophilia strains with the use of quinolones remains a concern [2]. The administration of TMP/SMX can be associated with adverse events such as neutropaenia, hepatopathy or decreased tubular secretion of creatinine and also with more uncommon severe skin diseases such as Stevens-Johnson syndrome or with central nervous system side effects [3]. However, the complication rate in this study was low.…”

“…A high dose of TMP (15 mg/kg/day) is generally recommended to reduce the risk of emerging resistance to TMP/SMX [1]. However, allergic reactions and toxicities related to the administration of TMP/SMX in patients limit the use of this drug in clinical practice [3]. Fluoroquinolones are an alternative option for treatment, if the pathogen is shown to be susceptible to the specific antimicrobial in vitro [1,2].…”