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Old Mon Aug 9, 2010, 03:57 PM
Lisa V Lisa V is offline
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Join Date: Aug 2006
Location: Waimanalo, Hawaii
Posts: 401
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.
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-Lisa, husband Ken age 60 dx SAA 7/04, dx hypo MDS 1/06 w/finding of trisomy 8; 2 ATGs, partial remission, still using cyclosporine
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