trimethoprim--sulfamethoxazole-drug-combination and Anaphylaxis

Hypersensitivity to zidovudine is an uncommon complication of antiretroviral therapy. Manifestations range from isolated fever to anaphylaxis. Fever and rash are the most common features. Diagnosis is made by rechallenge, although some patients have antibodies to zidovudine. Treatment is supportive, and symptoms resolve on withdrawal of the medication.

Topics: Adult; Anaphylaxis; Drug Hypersensitivity; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Zidovudine

Adverse effects are common in patients with acquired immunodeficiency syndrome (AIDS) who receive trimethoprim-sulfamethoxazole (TMP-SMX). Two patients experienced a rare anaphylactoid syndrome. Within hours of receiving a double-strength TMP-SMX tablet, a 28-year-old human immunodeficiency virus (HIV)-positive man developed fever, hypotension, and bilateral pulmonary infiltrates. Broad-spectrum antimicrobial therapy was begun but discontinued 2 days later when signs and symptoms resolved and specimens for Pneumocystis carinii were negative. A 38-year-old man developed rash, fever, hypotension, hyperbilirubinemia, renal dysfunction, and bilateral pulmonary infiltrates after taking two doses of oral TMP-SMX. Several antimicrobial agents, including parenteral pentamidine, were administered despite lack of evidence for P. carinii or other infection. four case reports of similar reactions in patients with AIDS have been published. Notable differences exist between the syndrome described and anaphylaxis. The TMP-SMX anaphylactoid reactions in patients with AIDS mimic sepsis or opportunistic infection, thus making diagnosis difficult.

Topics: Acquired Immunodeficiency Syndrome; Adult; Anaphylaxis; HIV Seropositivity; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination

Antibiotics are known to be able to cause hypersensitivity reactions through various mechanisms. We present a case of drug-induced immune thrombocytopenia (DITP) and anaphylactic shock occurring simultaneously in a dog after the administration of two classes of antibiotics, namely trimethoprim-sulfamethoxazole (TMP-SMX) and amoxicillin-clavulanate (AMC). The patient recovered completely from DITP on discontinuation of TMP-SMX and the anaphylactic shock caused by AMC was treated with intensive care. DITP is a rare adverse drug reaction (ADR), and anaphylactic shock is a life-threatening ADR. This is the first case report of a dog manifesting two types of hypersensitivity reactions caused by two antibiotics.

Topics: Amoxicillin; Anaphylaxis; Animals; Anti-Bacterial Agents; Clavulanic Acid; Dog Diseases; Dogs; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anaphylaxis; Basophil Degranulation Test; Basophils; Humans; Trimethoprim, Sulfamethoxazole Drug Combination

We report a patient with AIDS who had an anaphylactic-like reaction from trimethoprim-sulfamethoxazole. Clinical suspicion of anaphylaxis should be considered in patients presenting with fever, hypotension, eosinophilia, rash, flushing or pulmonary infiltrates after initial exposure and re-exposure to the medication. This case highlights the need for healthcare professionals to be reminded of the association between this unusual antibiotic reaction resembling sepsis and HIV disease.

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Anaphylaxis; Anti-Bacterial Agents; Drug Hypersensitivity; Female; Fever; Humans; Pneumonia, Pneumocystis; Transgender Persons; Trimethoprim, Sulfamethoxazole Drug Combination

The objective of this study was to present a case report that highlights the limitation of serum procalcitonin levels greater than 10 ng/mL as being almost exclusively secondary to septic shock. Data source was a medical intensive care unit patient at the University of Louisville. Anaphylactic shock may cause elevations of serum procalcitonin to levels greater than 10 ng/mL.

Topics: Anaphylaxis; Anti-Infective Agents; Calcitonin; Calcitonin Gene-Related Peptide; Female; Folliculitis; Humans; Middle Aged; Protein Precursors; Shock; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anaphylaxis; Anti-Infective Agents; Catheterization, Central Venous; Emergency Service, Hospital; Female; Humans; Radiography; Trimethoprim, Sulfamethoxazole Drug Combination; Vena Cava, Superior

A 23-year-old Japanese woman was diagnosed with lupus nephritis on May 2007. The patient was prescribed 30 mg/day of prednisolone, but developed a pulmonary abscess and was admitted to Sapporo Medical University Hospital in March 2008. Antibiotics improved the symptoms. We prescribed trimethoprim-sulfamethoxazole as prophylaxis for pneumocystis pneumonia; however, the patient developed fever and thrombocytopenia with hyperferritinemia after a week of this prophylaxis. We considered that she was developing hemophagocytic syndrome, and administered methylprednisolone pulse therapy. The clinical findings soon improved. However, when the prophylaxis was restarted, the patient developed fever, headache, and anaphylaxis the same day. Symptomatic therapy resolved these symptoms after three days, but they recurred on recommencing trimethoprim-sulfamethoxazole. Analysis of the cerebrospinal fluid revealed aseptic meningitis. These episodes were thought to be induced by trimethoprim-sulfamethoxazole. As trimethoprim-sulfamethoxazole is frequently used as prophylaxis for pneumocystis infection in immunosuppressed patients, clinicians should be vigilant regarding the complications of this treatment, particularly the rare occurrence of aseptic meningitis and anaphylaxis.

Topics: Anaphylaxis; Anti-Infective Agents; Antibiotic Prophylaxis; Female; Humans; Immunocompromised Host; Lupus Nephritis; Meningitis, Aseptic; Pneumonia, Pneumocystis; Prednisolone; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Anaphylactic reactions to cotrimoxazole are often ascribed to the sulphamethoxazole component of this antibacterial drug.. To determine whether the trimethoprim component can be the cause of an anaphylactic reaction.. An analysis was made of reports on anaphylaxis attributed to trimethoprim, as notified to the Drug Safety Unit of the Dutch Inspectorate for Health Care.. In the period between September 1981 and November 1995, 13 such reports were received. Nine were classified as probable anaphylaxis. Of these, the causal relationship between exposure to trimethoprim and anaphylaxis was classified as definite in three reports, and as probable in the other six. The remaining four reports were classified as possible anaphylaxis. In one of these, the causal relationship was classified as definite, and in three as probable.. Although anaphylaxis due to trimethoprim seems to be rare, it may be more common than previously thought. Apparently, anaphylaxis to cotrimoxazole is not always caused by sulphamethoxazole.

Topics: Adult; Aged; Anaphylaxis; Anti-Infective Agents, Urinary; Antibodies, Anti-Idiotypic; Female; Gastrointestinal Diseases; Humans; Male; Middle Aged; Respiratory Tract Diseases; Skin Diseases; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anaphylaxis; Anti-Infective Agents; Desensitization, Immunologic; Diagnosis, Differential; Drug Hypersensitivity; HIV Infections; Humans; Shock, Septic; Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anaphylaxis; Anti-Infective Agents, Urinary; Child; Drug Therapy, Combination; Epinephrine; Histamine H1 Antagonists; Humans; Hydrocortisone; Trimethoprim, Sulfamethoxazole Drug Combination

To study the outcome of a modified oral desensitization protocol for trimethoprim-sulfamethoxazole in human immunodeficiency virus infected patients with Pneumocystis carinii pneumonia and acquired immune deficiency syndrome.. A prospective study.. Tertiary care referral center.. Thirteen human immunodeficiency virus infected patients with Pneumocystis carinii pneumonia and allergy to sulfonamides who failed alternative therapy.. Oral desensitization to trimethoprim-sulfamethoxazole.. Nature of allergic reactions, toxicity of alternate medications, indication as well as outcome of trimethoprim-sulfamethoxazole desensitization and routine laboratory determinations.. The most common reaction to trimethoprim-sulfamethoxazole was generalized, pruritic maculopapular rash (n = 10, 76.9%) followed by urticaria/angioedema in two patients (15.38%). Two patients had generalized pruritus without rash. All patients (n = 13) tolerated oral desensitization to trimethoprim-sulfamethoxazole without any adverse reactions including three patients who were critically ill and on mechanical ventilation. Thus the success rate of our protocol was 100%. No patient had received antihistamines prior to or during the protocol. Four patients (5, 6, 7, and 9) were receiving prednisone for severe Pneumocystis carinii pneumonia. Total followup has ranged from 4 to 84 weeks. Two patients died during followup due to causes unrelated to desensitization. All other patients are tolerating trimethoprim-sulfamethoxazole without any allergic reactions.. Oral desensitization to trimethoprim-sulfamethoxazole, as per this protocol is safe, in that there were no systemic or cutaneous reactions during desensitization as well as followup. It is well tolerated in all patients, including the three critically ill patients. As judged by the outcome and ability to tolerate trimethoprim-sulfamethoxazole after desensitization, the procedure is successful in all patients in this study. Equipped with this protocol one can evaluate possible mechanisms of desensitization such as oral tolerance or mediator depletion in a controlled fashion.

Topics: Administration, Oral; Adult; AIDS-Related Opportunistic Infections; Anaphylaxis; Desensitization, Immunologic; Drug Hypersensitivity; Female; Humans; Male; Middle Aged; Pneumonia, Pneumocystis; Prospective Studies; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Trimethoprim-sulfamethoxazole (TMP-SMZ) is the drug of choice as prophylaxis for Pneumocystis carinii pneumonia in patients with AIDS. However, adverse reactions ascribed to TMP-SMZ are common in such patients. We previously described a rapid method of oral TMP-SMZ desensitization in patients with AIDS and varying degrees of intolerance to the drug. To assess the feasibility, safety, and long-term clinical utility of our desensitization protocol, we retrospectively studied 22 consecutive patients who underwent desensitization. Prior to the procedure each of the study subjects had exhibited moderate to severe reactions to TMP-SMZ. Desensitization was successfully completed in 19 (86%) of the patients. The three patients for whom desensitization failed experienced chills and/or vomiting that resolved promptly with symptomatic therapy. One of the 19 patients was unavailable for long-term follow-up. Of the remaining 18 patients, three discontinued taking TMP-SMZ within 2 weeks of desensitization because of macular rash and fever. The other 15 (71%) of the evaluable patients tolerated both desensitization and subsequent prophylaxis and took TMP-SMZ for a mean of 14 months (in some cases, for as long as 41 months). None had P. carinii pneumonia while receiving TMP-SMZ. These results indicate that most patients who are presumed to be TMP-SMZ-intolerant can be rapidly desensitized with oral TMP-SMZ and subsequently receive the drug for protracted periods as effective prophylaxis for P. carinii pneumonia.

Topics: Acquired Immunodeficiency Syndrome; Administration, Oral; Adult; Anaphylaxis; Desensitization, Immunologic; Female; Follow-Up Studies; Humans; Male; Pneumonia, Pneumocystis; Retrospective Studies; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Administration, Oral; Anaphylaxis; Child; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination

An unusual acute hypotensive syndrome has been observed in association with administration of trimethoprim-sulfamethoxazole (TMP-SMZ) to patients with human immunodeficiency virus (HIV) infection. In the 11 cases that have been reported, the syndrome differs from classic anaphylaxis and resembles septic shock. Mediation by tumor necrosis factor (TNF) has been hypothesized, but the mechanism has not been characterized with cytokine assays, and no invasive hemodynamic measurements have been reported. We describe a case of recurrent hyperdynamic shock--without classic features of anaphylaxis, without detectable IgE antibodies against TMP or SMZ, and without detectable levels of TNF--involving an HIV-infected patient rechallenged with TMP-SMZ.

Topics: Adult; AIDS-Related Opportunistic Infections; Anaphylaxis; Complement System Proteins; Fever; Hemodynamics; Humans; Hypotension; Interleukin-6; Male; Pneumonia, Pneumocystis; Shock; Trimethoprim, Sulfamethoxazole Drug Combination; Tumor Necrosis Factor-alpha