Question - Bactrim Causing AA?
 

Has anybody ever heard of the antibiotic Bactrim causing AA? During my treatment, after ATG, I was on Bactrim to prevent infection while my WBC was lower than normal, so my doc must not have been very concerned about the drug causing any sort of relapse. However, my sister was recently prescribed this drug for an infection, and as soon as she read in the symptoms that it can cause AA, she requested a different antibiotic.

I'm very curious if anybody has ever heard of AA as a symptom of taking Bactrim. I'm not sure, but I think it or a variant of it may have been prescribed to me as a teenager to prevent acne. I think it goes by any of the following names - Bactrim, Septra, Septrin, Apo-Sulfatrim, SMZ-TMP and co-trimoxazole.

They did put John on Bactrim 3x/wk as a preventative measure against lung infections. But he developed a rash and they switched him to Dapsone. The link below has the adverse side effects of Bactrim, and yes, AA is one of them.
I think the SAA shows up while on the drug or shortly after.

http://www.rxlist.com/bactrim-drug.htm

Ken was prescribed Bactrim following minor surgery, and I noticed that warning too, so I contacted our hem/onc pharmacist. He told me the virtually ALL antibiotics carry some risk of triggering AA, that's just how they work. It's probably not that the doctor is not concerned about it, just that the risk is lower than the risk of untreated infection, so they make a judgement call.

In this instance the pharmacist suggested a switch to Cephalexin, as he felt it was one of the safer ones. It worked fine. I'm not sure what factors influence their selection of one antibiotic over another, but I suspect that not all of them have to do with medical efficacy. Hospital pharmacies may carry only certain versions of a drug in their formularies, and there are often economic and other incentives to use certain ones.

In any case, under the circumstances, the routine use of Bactrim as a PCP (pneumocystis pneumonia) prophylaxis on some AA patients seems kind of questionable to me. I asked our doctor about that and he agreed. He's never proscribed Pentamidine either, or any other type of PCP prophylaxis for that matter. He considers it to be a slippery slope (once you start, when do you stop?), but I've heard from several other patients who have gotten it and just assumed it was standard protocol.

If John needs an antibiotic, we always ask for the least offensive one. We have found they are very quick to prescribe Levaquin and we always have to request a less toxic one. Levaquin and other antibiotics in that class cause nerve problems and since John has nerve damage from drugs already, it doesn't make sense to use this unless there is no other option. I think they get comfortable with their drug of choice and don't really take into consideration all the other issues a person has when decided on a drug. Levaquin should never be prescribe as the a first line of treatment antibiotic especially since there are others out there that are effective.

Where I was previously treated I was never put on anything. However, where I have been currently treated when you are neutropenic or on steroids and after transplant I was on Levaquin, Bactrim and an antifungal. They use Voriconazole but that affected my liver enzymes so I was switched to Posaconazole. This is the standard here and they have firm beliefs that is a necessity.

After transplant they do not start the Bactrim until your ANC is over 1000 incase it should slow the growth.

Laura

Thank you everyone for the helpful information! I was shocked to hear about how severe some antibiotics can be, and although it can be reasonable if you are suffering from/or trying to prevent a very dangerous infection, I certainly hope it was not what I was prescribed by my dermatologist at such a young age for such a minor problem. I am waiting on my medical records.

Thank you for sharing your knowledge with me! I hope to always be learning more about AA, and it is also a relief to hear that it can be or has been prescribed for other patients post-ATG.

re: Bactrim
 

Back in the late 80's I used Bactrim all the time for recurrent urinary tract infections. It was pretty standard back then. Now, my docs are more inclined to prescribe Cipro.
After my Campath trial at NIH for MDS, they use Pentamidine for PCP (pneumocystis pneumonia) prophylaxis. They say you can use Bactim instead if you want. I typically don't, because it can lower white counts. So, I get my Pentam monthly at Univ. of PA hospital. It is necessary to protect against PCP until CD4 counts are above 200. So it really is a necessity if you want to protect against PCP. (at least on my trial.....)

Interesting. Low-dose Bactrim, minocycline, clindamycin and azithromycin are used on the Marshall Protocol, which I will be working through (I just had ATG). Minocycline is supposed to have some kind of modulatory effect on T cells, maybe Bactrim does too. I wasn't on mino long enough to see if it would work or not, but I did have some of my lowest lymphocyte counts (0.4) in the short time I took it. I'm the only AA patient on it, but it is helping people with a wide range of other autoimmune diseases.

I do believe there is a lot about common drugs that medicine does not know about, and has still to find out.

Deb

Bactrim Caused My AA
 

I thought I would chime into this thread to share my experience with Bactrim. In my case, my Aplastic Anemia was definitely caused by the drug. Beginning December 14th, 2010 I took a course of Bactrim to combat a standard urinary tract infection. I had never had a UTI before, nor had I taken a sulfa-based drug before. Within the first few days, I noticed I had itchy dry patches on the back of my neck and under my arms on my torso. It didn’t look like a rash to me, and I just thought I had dry skin. I should have stopped taking the drug immediately, but never having had an allergic reaction to a medication before, I completed the full ten-day course. Two days later, I began my period – early. The period was unusually painful and lasted over eight days – a major shift from my normal 5. I was diagnosed less than three weeks later with SAA. Conveniently, I had a blood test two weeks prior to my taking the Bactrim and all counts were normal, so my doctors at Cedars-Sinai in Los Angeles and I have concluded together that the sulfa antibiotic caused my disease.

My son was given bactrim 3x to combat MRSA from Sept to Feb of 2011. His blood counts were never drawn which is the drug manufactures recomendation. His last dose of Bactrim was Feb 23 2011. On March 23 he was admitted to the ICU of OSU hospitial with a wbc 2.2 hgb 3.1, plateletts 5 and ANC .01. When it first happened I got on the internet searching for any reason this happened and combing through his medical records. What I found was Bactrim is banned in other countries. There was a writer I think in England who pushed to have it banned by combining all of his readers responses to the drug. This was all while we were in the middle of the crisis of ICU so I dont recall everything but I do know that everything I read told me to stay away from Bactrim. I don't know if it was the cause of Trevor's disease, I do know that noone ever checked his counts while he was on extended doses of this drug which may have caused them to see his numbers slip earlier. But since you will never know what the cause may have been , you work to address where you are now and look for other options if possilbe. Unfortunatly Trevor is in the prison system and it is the only antibiotic they use. (I wonder what that means) So when he developed an infection since he began ATG/cyclosporin they put him on Bactrim. He doesnt get a choice. Your sister does, I would take it.

Hi,

I couldn't help having my say here. My brother had sulpha drugs as a child. Within a few weeks he was admitted to hospital with GI bleeding and vomiting blood. Blood tests showed very low counts (many years ago and don't remember numbers). He had many transfusions and high dose prednisone and his counts rebounded.

50 years later he still has thrombocytopenia (occasionally requiring platelet transfusions) which has been changed from ITP to Lupus but it definitely started after his sulpha drugs all those years ago.

Regards