trimethoprim--sulfamethoxazole-drug-combination and Thrombophlebitis

Salmonella enterica serovar typhi causes one of the most common blood stream infections, the typhoid fever. However, it can cause pyogenic infections involving different sites as well. Extensively drug resistant (XDR) strains of Salmonella typhi are resistant to all first line anti-typhoidal drugs (chloramphenicol, ampicillin and trimethoprim-sulfamethoxazole) as well as ciprofloxacin and ceftriaxone. XDR-strains were first reported from Pakistan in 2016, and since then the strains have been spreading. These XDR Salmonella cases not only pose a therapeutic challenge but also predispose to complications as a result of prolonged illness and delayed treatment. Here, we report a case of superficial thrombophlebitis at intravenous cannula site in a 49-year male, who was being treated for XDR-typhoid fever. To the best of our knowledge, thrombophlebitis of a superficial vein is an unusual complication of Salmonella typhi, not previously reported in literature. Key Words: Bacteremia, Thrombophlebitis, Extensively drug-resistant, Typhoid fever, Salmonella typhi.

Topics: Anti-Bacterial Agents; Humans; Male; Microbial Sensitivity Tests; Pakistan; Salmonella typhi; Thrombophlebitis; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

We report an unusual and severe vasculitic disorder following co-trimoxazole, given orally for a urinary tract infection. The vasculitis was manifest solely as thrombophlebitis migrans and involving only veins without evidence of polyarteritis nodosa, or underlying malignancy.

Topics: Anti-Infective Agents, Urinary; Drug Combinations; Humans; Male; Middle Aged; Sulfamethoxazole; Thrombophlebitis; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Eight acute spinal injury patients with deep vein thrombosis and/or pulmonary emboli are presented witn an in-depth analysis and management of anticoagulation therapy. Special considerations for acute spinal cord injury patients with regards to prophylactic and therapeutic anticoagulation by heparin and coumadin are discussed. There was a wide variation in the requirement of heparin and/or coumadin to maintain effective coagulability which could only be elicited by frequent laboratory monitoring. Inadequate dose and shorter duration of administration of anticoagulant resulted in recurrence of thromboembolism in three out of eight patients in the present series. Haemorrhagic complications were minor and easily manageable. Co-trimoxazole potentiation of coumadin action occurred in two of our patients and it requires special mention as the drug is used increasingly in the treatment of urinary tract infections.

Topics: Administration, Oral; Adult; Anticoagulants; Drug Combinations; Drug Interactions; Hematuria; Heparin; Humans; Injections, Subcutaneous; Male; Middle Aged; Pulmonary Embolism; Spinal Cord Injuries; Sulfamethoxazole; Thrombophlebitis; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Warfarin