Side Effects of co-trimoxazole: A Synthesis of Findings from 24 Studies

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Original Abstract of the Article

Key Research Findings

Cotrimoxazole is an antibiotic commonly prescribed for bacterial infections. However, numerous studies have highlighted the potential for cotrimoxazole to cause adverse effects. 14 revealed a correlation between cotrimoxazole use and an increased risk of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). 11 indicated that cotrimoxazole might exacerbate pneumonia in immunocompromised patients, particularly those prone to infections from Stenotrophomonas maltophilia (S. maltophilia). Additionally, 24 suggested a possible link between cotrimoxazole and pneumonia development in patients diagnosed with hematologic malignancies.

Reasons for Side Effects

Side effects associated with cotrimoxazole can stem from its components, trimethoprim and sulfamethoxazole. Trimethoprim can hinder the formation of blood cells by interfering with folate metabolism. On the other hand, sulfamethoxazole has the capacity to trigger allergic reactions. , 2 , 9

Common Side Effects

Blood Disorders

Cotrimoxazole can lead to a decrease in the number of blood cells. This can be attributed to the interference of trimethoprim with folate metabolism. , 2 , 1 , 9

Gastrointestinal Symptoms

Cotrimoxazole can cause gastrointestinal symptoms such as nausea, vomiting, and diarrhea. 20 , 9

Skin Reactions

Cotrimoxazole can trigger skin reactions including rash, itching, and redness. In severe cases, it can lead to serious skin reactions like Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). 14 , 9 , 17

Liver Damage

Cotrimoxazole can cause damage to the liver. 23 , 5

Kidney Damage

Cotrimoxazole can potentially damage the kidneys. 23 , 5

Allergic Reactions

Cotrimoxazole can provoke allergic reactions. These reactions can manifest as rash, itching, difficulty breathing, and anaphylaxis. 9

Hypoglycemia

Cotrimoxazole may induce low blood sugar levels. 23 , 15 , 20

Countermeasures for Side Effects

Blood Disorders

To mitigate the risk of blood disorders, doctors may recommend regular blood tests. Additionally, taking folic acid supplements might be suggested. 2

Gastrointestinal Symptoms

To alleviate gastrointestinal symptoms, doctors may prescribe anti-emetics or antidiarrheal medications. 20

Skin Reactions

If skin reactions arise, it's essential to seek medical advice. Doctors may prescribe steroid ointment or antihistamines. 9

Liver Damage

To reduce the likelihood of liver damage, doctors may conduct regular liver function tests. 23

Kidney Damage

To minimize the risk of kidney damage, doctors may perform routine kidney function tests. Staying adequately hydrated is also crucial. 23

Allergic Reactions

In the event of an allergic reaction, immediate medical attention is imperative. Doctors may prescribe antihistamines or steroids. In severe cases, epinephrine administration may be necessary. 9

Hypoglycemia

To mitigate the risk of hypoglycemia, doctors may regularly monitor blood sugar levels. Dietary and exercise modifications may also be recommended. 20

Comparison Between Studies

Similarities in Studies

A common thread across numerous studies is the identification of cotrimoxazole's potential to cause diverse side effects. These include blood disorders, skin reactions, gastrointestinal symptoms, liver damage, kidney damage, allergic reactions, and hypoglycemia.

Differences in Studies

Research findings vary regarding the specific types and severity of side effects induced by cotrimoxazole. For instance, 14 highlights the association between cotrimoxazole and an elevated risk of SJS/TEN, while 11 points to a possible exacerbation of pneumonia in immunocompromised patients.

Cautions for Application in Daily Life

While cotrimoxazole proves effective in treating bacterial infections, it carries the potential for various side effects. Therefore, when taking cotrimoxazole, it's essential to adhere strictly to your doctor's instructions and seek medical advice promptly if any side effects arise.

Limitations of Current Research

The research landscape surrounding cotrimoxazole's side effects remains incomplete. Further research is needed, particularly regarding the impact of cotrimoxazole on specific populations, such as the elderly and children.

Future Research Directions

Further research is crucial to enhance our understanding of cotrimoxazole's side effects. This includes delving deeper into the mechanisms underlying these effects, the impact on specific populations, and the development of methods to prevent or mitigate these side effects.

Conclusion

Cotrimoxazole, while effective against bacterial infections, carries the potential for diverse side effects. To minimize these risks, it's paramount to follow your doctor's instructions carefully and undergo regular health checkups. Continued research is essential to understand cotrimoxazole's impact better, particularly focusing on preventive strategies and the effects on specific patient groups.

Literature analysis of 24 papers
Positive Content
14
Neutral Content
3
Negative Content
7
Article Type
0
0
1
4
21
1.

[Serious side effects of frequently used antibiotics in childhood: biliary sludge or stones induced by ceftriaxone and thrombocytopenia induced by co-trimoxazole].

Author: VoetenM, LandstraA M, MaselandM H H, van SettenP A

Cholecystitis
Cholelithiasis
Thrombocytopenia

Ceftriaxone and co-trimoxazole are antibiotics that can cause serious side effects in children. Ceftriaxone can cause cholecystitis, while co-trimoxazole can cause thrombocytopenia. It is important to ensure a correct dosage in children, since side effects are potentially dose-related.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : Dutch

2.

Hematological side effects of co-trimoxazole.

Author: HeimpelH, RaghavacharA

Easily treated side effects
Blood cell decrease
Life-threatening side effects

Co-trimoxazole can cause blood cell decrease. Trimethoprim side effects are frequent, dose-dependent, and often manageable with folate supplementation. Sulfamethoxazole side effects are rare but can be life-threatening and require immediate treatment.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

3.

Efficacy and safety of co-trimoxazole in eradication phase of melioidosis; systematic review.

Author: KeragalaKeragala Arachchige Reshani Kaumada, GunathilakaMaththe Gama Ralalage Shobha Sanjeewani, SenevirathnaRathnabahu Mudiyanselage Indika Sanjeewa Kumara, JayaweeraJayaweera Arachchige Asela Sampath

Melioidosis treatment

This systematic review aimed to examine the optimal dose, duration, and combination of co-trimoxazole therapy for the eradication phase of melioidosis, an infectious disease caused by *Burkholderia pseudomallei*. While co-trimoxazole has been used for years, there is a lack of uniformity in treatment protocols and a need for more robust data on its efficacy and safety profile in the eradication phase of melioidosis.

Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

5.

[Adverse drug reactions to multiple antibiotics].

Author: ScolariMariano, TrovatoDaiana, KotLilian, ErnstGlenda

Multidrug intolerance syndrome

This case report describes a woman diagnosed with multisensitive Staphylococcus aureus endocarditis who experienced adverse reactions to five different antibiotics in two hospitalizations. This case may be an example of multidrug intolerance syndrome, an under-reported entity, or an as-yet uncharacterized condition.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
English AbstractA summary of a research paper/publication written in English for a wider audience.

Language : Spanish

8.

Evaluating the risk-to-benefit ratio of using cotrimoxazole as a pneumocystis pneumonia preventative intervention among pemphigus patients treated with rituximab: A retrospective study with 494 patients.

Author: FarajiHannaneh, DaneshpazhoohMaryam, EhsaniAmir Hooshang, MahmoudiHamidreza, TavakolpourSoheil, AryanianZeinab, AslaniSaeed, KhodaveisiHamidreza, BalighiKamran

Pemphigus treatment
Infections

This study evaluated the prophylactic efficacy of cotrimoxazole in preventing pneumocystis pneumonia (PCP) in pemphigus patients treated with rituximab. The study found that cotrimoxazole did not significantly reduce the risk of PCP and may not be necessary.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

11.

Co-morbidity of Covid-19 and Stenotrophomonas maltophilia in a Patient with Hodgkin's Lymphoma History from North of Iran.

Author: DarvishniaDavid, SadeghiMahdieh, SharifpourAli, ZakariaeiZakaria, BanimostafaviElham Sadat, FakharMahdi, TabaripourRabeeh

Multidrug resistance

Stenotrophomonas maltophilia (S. maltophilia) is a multidrug-resistant gram-negative bacillus that can cause a challenge in the management of immunocompromised patients, particularly those hospitalized. This study focuses on the management of patients with concomitant COVID-19 and S. maltophilia pneumonia.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.

Language : English

12.

Current Understanding and Unknown Aspects of the Treatment of Granulomatosis with Polyangiitis (Wegener's Granulomatosis): Opportunities for Future Studies.

Author: AlesaeidiSamira, DarvishiMohammad, DabiriSasan, GhasemiAdlMojtaba, JafariehArash, TavakolpourSoheil

GPA remission
Pregnancy GPA management
Safer GPA treatment
Cancer risk
Infertility
Poor GPA outcomes

Granulomatosis with polyangiitis (GPA) is a rare, systemic autoimmune disease. Most patients with GPA have circulating anti-neutrophil cytoplasmic antibodies (ANCA) directed against proteinase 3 (PR3). This review discusses the current and potential treatments for GPA. Cyclophosphamide (CYP) is effective for remission induction but has serious side effects. Rituximab (RTX) appears to be a safer and equally effective alternative for both remission induction and maintenance. IVIg is used for pregnant patients, and co-trimoxazole may prevent relapse. Other therapeutic options include 15-deoxyspergualin and plasma exchange. Potential treatments include ofatumumab, ocrelizumab, belimumab, atacicept, tabalumab, abatacept, and Janus kinase inhibitors. Poor outcomes are associated with renal involvement, older age, baseline organ damage, delayed diagnosis, rising creatinine levels, and higher neutrophil/lymphocyte ratio. Further research is needed to address controversial issues like optimal medication dosages, predicting treatment response, and managing GPA in children and pregnant women.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

13.

Investigations into the physical and chemical stability of concentrated co-trimoxazole intravenous infusions.

Author: KhaleelIsraa, ZaidiSyed Tabish R, ShastriMadhur D, EapenMathew Suji, MingLong Chiau, WanandyTroy, PatelRahul P

Pneumonia Treatment
Fluid Overload

This study investigated the physicochemical stability of concentrated intravenous co-trimoxazole solutions to potentially reduce the risk of fluid overload associated side effects.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

14.

Incidence of Stevens-Johnson syndrome/toxic epidermal necrolysis among new users of different individual drugs in a European population: a case-population study.

Author: Rodríguez-MartínSara, Martín-MerinoElisa, LermaVictoria, Rodríguez-MiguelAntonio, GonzálezOlga, González-HerradaCarlos, RamírezElena, BellónTeresa, de AbajoFrancisco J

SJS/TEN

A case-population study in Madrid found that phenytoin had the highest incidence of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), followed by allopurinol and cotrimoxazole.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

15.

Consecutive hypoglycemia attacks induced by co-trimoxazole followed by pentamidine in a patient with acquired immunodeficiency syndrome.

Author: OkazakiMoemi, OkazakiMasafumi, NakamuraMiho, AsagiriTadashi, TakeuchiSeisho

PCP treatment
Hypoglycemia

A case report describes a patient with AIDS who developed hypoglycemia as an adverse effect of both co-trimoxazole and pentamidine, highlighting the importance of awareness among physicians treating patients with AIDS and PCP.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

16.

Antibiotic-Resistant E. coli in Uncomplicated Community-Acquired Urinary Tract Infection.

Author: KlingebergAnja, NollInes, WillrichNiklas, FeigMarcel, EmrichDagmar, ZillEdith, Krenz-WeinreichAnnegret, Kalka-MollWiltrud, OberdorferKlaus, SchmiemannGuido, EckmannsTim

Antibiotic Resistance

Urine cultures are not always needed to diagnose simple urinary tract infections. This study looked at the effectiveness of trimethoprim and cotrimoxazole, two common antibiotics, against E. coli bacteria in urinary tract infections. The study found that resistance to these drugs was higher than reported in national surveillance data.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

17.

Drug-induced oral erythema multiforme: A diagnostic challenge.

Author: TaqiSyed Ahmed

Infection treatment
Oral erythema multiforme

Trimethoprim-sulfamethoxazole (TMP/SMX) can cause adverse reactions in 1%-3% of patients. A case of oral erythema multiforme (EM) secondary to TMP/SMX is reported.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.

Language : English

19.

Trimethoprim-sulfamethoxazole therapy for patients with carbapenemase-producing Klebsiella pneumoniae infections: retrospective single-center case series.

Author: MurriRita, FioriBarbara, SpanuTeresa, MastrorosaIlaria, GiovannenzeFrancesca, TaccariFrancesco, PalazzoloClaudia, ScoppettuoloGiancarlo, VenturaGiulio, SanguinettiMaurizio, CaudaRoberto, FantoniMassimo

Kp-KPC infection treatment
Adverse events

This case series investigated the efficacy and tolerability of trimethoprim-sulfamethoxazole (TMPS) in treating Klebsiella pneumoniae (Kp)-K. pneumoniae carbapenemase (KPC) infections. The study found that TMPS was effective in treating TMPS-susceptible Kp-KPC infections, with a cure rate of 71.4%.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

20.

Acute glycaemic effects of co-trimoxazole at prophylactic dose in healthy adults.

Author: KenteuBernold, NoubiapJean Jacques N, EtoaMartine Claude, Azabji-KenfackMarcel, DehayemMesmin, SobngwiEugene

Hypoglycemia

This study investigates the acute effects of co-trimoxazole at prophylactic doses on glucose metabolism in healthy adults to determine if it causes hypoglycemia similar to that seen in HIV/AIDS patients receiving higher doses.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

23.

Adverse Drug Reactions Causing Admission to Medical Wards: A Cross-Sectional Survey at 4 Hospitals in South Africa.

Author: MoutonJohannes P, NjugunaChristine, KramerNicole, StewartAnnemie, MehtaUshma, BlockmanMarc, Fortuin-De SmidtMelony, De WaalReneé, ParrishAndy G, WilsonDouglas P K, IgumborEhimario U, AynalemGetahun, DhedaMukesh, MaartensGary, CohenKaren

Adverse drug reactions

In South Africa, approximately 1 in 12 adult hospital admissions are due to adverse drug reactions (ADRs), with the most common ADRs being renal impairment, hypoglycemia, liver injury, and hemorrhage.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.

Language : English

24.

How to manage lung infiltrates in adults suffering from haematological malignancies outside allogeneic haematopoietic stem cell transplantation.

Author: MaschmeyerGeorg, DonnellyJ Peter

Improved clinical outcome
Pulmonary complications

Pulmonary complications are common in patients with severe neutropenia. This abstract discusses the differential diagnosis, diagnostic procedures, and treatment options.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

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