Haemolytic anaemia and renal failure associated with antibodies to trimethoprim and sulfamethoxazole

Abstract

We describe a patient who appeared to have haemolytic anaemia and renal failure associated with antibodies to both TMP and SMX.

Antibodies to co‐trimoxazole (trimethoprim and/or sulfamethoxazole) related to the presence of the drug in a commercial low‐ionic‐strength solution

“…In this report, we detailed three different cases where subjects producing antibodies against co‐trimethoxazole showed different antibody patterns: antibodies to both co‐trimethoxazole components (i.e., antibodies against TMP and antibodies against SMX) or antibodies against one component of co‐trimethoxazole only (antibodies against TMP or antibodies against SMX). These different patterns of antibody reactivity, also described by Arndt and coworkers 11 and Gupta and coworkers, 13 support the evidence that immune response elicited by a given drug is an individual response to antigenic challenge governed by many factors.…”

“…Antibodies against co‐trimethoxazole may be a serologic finding without clinical features. These antibodies have been associated with DIIHA and renal failure previously 11,21 . In a general manner, healthy subjects can have drug‐dependent antibodies in their sera, as penicillin antibodies notably 2,22 .…”

“…We demonstrated, using the same gel method, that the same serum containing antibodies against co‐trimethoxazole gave positive reactions with native or enzyme‐treated RBCs when using a diluent containing the drug in question, but negative reactions with native or enzyme‐treated RBCs when using a diluent without the drug (Table 1). In the discussion of their case, Arndt and colleagues 11 have described three possible explanations for their results. In our study, only one explanation could be retained because there was no recent intake of the drug (1 week), and we only used the gel method.…”

“…These antibodies have been associated with DIIHA and renal failure previously. 11,21 In a general manner, healthy subjects can have drug-dependent antibodies in their sera, as penicillin antibodies notably. 2,22 Despite the absence of clinical events associated with the presence of these antibodies in this report, our recommendation for these subjects is to avoid the use of co-trimethoxazole.…”

Risk Factor Analysis Among Trimethoprim-Sulfamethoxazole Resistant Escherichia coli Isolates

“…One of the most prevalent bacterial families is Enterobacteriaceae, a group of aerobic Gram-negative bacilli including Escherichia coli, which are the most prevalent causes of urinary tract infections (1)(2)(3). Antimicrobial resistance among Enterobacteriaceae has been increasing in recent years.…”