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Bactrim/Septra-An Antibiotic Cocktail Which Causes Stevens-Johnson Syndrome

Brand name antibiotic treatments Bactrim and Septra are one of those potentially dangerous combos. This combined antibiotic treatment is known as trimethoprim-sulfamethoxazole. Both drugs reduce the ability of some bacteria to utilize folic acid for growing. The combination of the two is much more effective than either by themselves. The drugs are prescribed together for a variety of medical issues and illnesses. It is a relatively common for a Bactrim/Septra prescription to be given for ear and urinary tract infections in children, and is also used in the treatment of bronchitis, travel-related diarrhea, and pneumonia.

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 Sulfamethoxazole-Trimethoprim for Skin and Soft Tissue Infections: 1 or 2 Tablets BID?

The 2014 Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections (SSTI) recommend sulfamethoxazole-trimethoprim (SMX-TMP) for purulent infections where methicillin-resistant S. aureus (MRSA) is a likely pathogen. 1 But, what dose of SMX-TMP should we be prescribing? Both the SSTI and MRSA guidelines say 1-2 double strength tablets twice a day. 1,2 So, which is it, 1 tablet or 2?

Articles of Interest

Antibiotic Therapy for Abscesses Medical Dogma Challenged by Evidence-Based Research, Outcomes

It’s not the cutting that’s at issue, rather the tenet that antibiotics don’t lead to any better outcomes after adequate drainage, just more cost and side effects. That’s what’s been taught and was supported by small studies, including two randomized placebo-controlled trials (RCTs) of approximately 200 total participants each done during the MRSA era.

Bactrim Adverse Events

Bactrim (TMP-SMX) is a sulfa antibiotic used for a number of infections but can have untoward effects. Hypoglycemia can be induced by the sulfa component of Bactrim, which binds receptors in the pancreas causing insulin to be secreted, dropping blood sugar levels.

Trimethoprim Sulfamethoxazole

More serious reactions can include Stevens-Johnson syndrome, various anemias, agranulocytosis, C. diff.-associated diarrhea, myelosuppression, renal failure/interstitial nephritis, pancreatitis, and hepatotoxicity. Hemolytic anemia can occur with sulfa drugs like sulfamethoxazole in patients with a glucose-6-phosphate-dehydrogenase (G6PD) deficiency.

Trimethoprim-Sulfamethoxazole for Uncomplicated Skin Abscesses?

Assuming adequate drainage is performed, I will implement the “wait and see “ approach and offer antibiotics to patients if their symptoms worsen, or do not clinically improve, within 48-72 hours. For patients who have had multiple abscesses in the past, however, I am more likely to recommend TMP-SMX at the onset as this study suggests in their secondary outcome what we found in earlier studies, a decreased recurrence rate of new lesion development in the group who had antibiotics.

Trimethoprim-Sulfamethoxazole–Induced Life-Threatening Agranulocytosis

Sulfamethoxazole/Trimethoprim (TMP-SMX) interacts with multiple medications to varying degrees.

Resources

Trimethoprim Sulfamethoxazole (Bactrim, Septra): Drug Monograph

Sulfamethoxazole inhibits bacterial synthesis of dihydrofolic acid by competing with para-aminobenzoic acid. Trimethoprim blocks the production of tetrahydrofolic acid from dihydrofolic acid by binding to and reversibly inhibiting the required enzyme, dihydrofolate reductase. Thus it blocks two consecutive steps in the biosynthesis of nucleic acids and proteins essential to bacteria