개의 눈물착색증후군(Tear Statining Syndrome) 치료를 위한 Trimethoprim-Sulfamethoxazole

조연숙,김준영,정순욱 한국임상수의학회 2008 한국임상수의학회지 Vol.25 No.2

22 dogs (31 eyes) that had treated with trimethoprim-sulfamethoxazole for tear staining syndrome at Snoopy Pet Clinic from October 2000 to September 2002 were reviewed. Of the 22 dogs, 12 were female and 10 male. Their mean (± SD) age was 3.5 (± 1.3) years. The breeds of the dogs consisted of Maltese (8 dogs), Shih tzu (6 dogs), Poodle (5 dogs), Yorkshire terrier (2 dogs), and Mixed (1 dog). The dogs received 30 mg/kg trimethoprim-sulfamethoxazole perorally twice daily for two to six weeks. 26 (19 dogs) of the 31 eyes (22 dogs) recovered completely and did not show relapse at 26~30 weeks after treatment. Any complications did not observed. Five eyes of three dogs were not cured. Two eyes (one dogs) of them had not response to medicament and three eyes (two dogs) recurrence but the clinical signs decreased. It was considered that the trimethoprim-sulfamethoxazole was effective for the treatment in dogs with tear staining syndrome.

증례 : 알레르기 ; 박트림에 의한 아나필락시스 1예

김성무 ( Sung Moo Kim ),김경숙 ( Kyung Sook Kim ),김미경 ( Mi Kyung Kim ) 대한내과학회 2011 대한내과학회지 Vol.80 No.3

내원 5년 전 우측 신장 이식술 시행 후 박트림을 복용하였던 만성신부전 환자가 최근 만성중이염으로 박트림을 복용 후 전신두드러기, 혈관부종과 저혈압을 경험하여, 치료 후박트림을 복용하지 말라고 교육하였지만, 만성중이염이 지속되어 환자 스스로 박트림을 다시 복용하여 저혈압과 혈관부종, 전신 두드러기 등 증상이 재발하였다. 박트림으로 피부단자 검사를 시행하여 강양성반응이 나타나 박트림에 의한 아나필락시스임을 확진하였으며 면역효소법과 면역효소억제능 검사 결과 박트림의 다섯 가지 구성성분 중 sulfamethoxazole이 원인 알레르겐임을 확인하였다. Bactrim consists of the sulfonamides trimethoprim and sulfamethoxazole. These induce relatively frequent adverse drug reactions, including allergic reactions ranging from urticaria to anaphylaxis. Either component can be the causative allergen, so it is necessary to determine which has caused an allergic reaction to prevent further allergy. We report the case of a 46-year-old male with chronic renal failure who experienced anaphylactic shock twice after ingesting trimethoprim-sulfamethoxazole, as was proven by the medical history and skin prick testing. Enzyme-linked immunoassays and enzyme-linked allergen inhibition assays for allergen-specific IgE antibody for the five components of Bactrim showed that sulfamethoxazole was the causative allergen. (Korean J Med 2011;80:365-369)

Trimethoprim-sulfamethoxazole에 대해 지연성 과민반응을 보인 환자에서 성공적인 급속 탈감작 치료 사례 1예

윤도란 ( Doran Yoon ),안홍근 ( Hongkeun Ahn ),김세용 ( Se Yong Kim ),황성준 ( Seong Jun Hwang ),박한기 ( Han Ki Park ),강혜련 ( Hye Ryun Kang ) 대한천식알레르기학회(구 대한알레르기학회) 2015 Allergy Asthma & Respiratory Disease Vol.3 No.2

Trimethoprim-sulfamethoxazole (TMP-SMX) is an antibiotic used for the treatment or prophylaxis of Pneumocystis pneumonia and other infectious conditions. Sulfonamide derivatives have been reported to cause delayed hypersensitivity reactions, resulting in switch to less effective second-line antibiotics. Although desensitization is traditionally known to be effective in patients with imme￢diate hypersensitivity, it is also applied to the treatment of delayed hypersensitivity in recent years. A 66-year-old female who had a history of repeated TMP-SMX-induced delayed hypersensitivity presenting as whole body rashes needed to take prophylactic dose of TMP-SMX (80/400 mg daily) before initiation of chemotherapy for multiple myeloma. Intravenous rapid desensitization was per￢formed by using a 11-step, 4-bottle protocol from 1:1,000 to 1:1 solution for 3 hours to reach the target dose for prophylaxis. After successful rapid desensitization of TMP-SMX, 1-month prophylaxis was completed without any complications until the patient re-covered normal immunity. We herein reported a case of delayed hypersensitivity reaction to TMP-SMX in an about-to-be immuno￢compromised host with planned chemotherapy who successfully completed 1-month prophylaxis with the drug without any com￢plications through rapid desensitization.(Allergy Asthma Respir Dis 2015;3:155-158)

Characterization of Trimethoprim-Sulfamethoxazole Resistance Genes and Their Relatedness to Class 1 Integron and Insertion Sequence Common Region in Gram-Negative Bacilli

( Hae Won Shin ),( Jinsook Lim ),( Semi Kim ),( Jimyung Kim ),( Gye Cheol Kwon ),( Sun Hoe Koo ) 한국미생물 · 생명공학회 2015 Journal of microbiology and biotechnology Vol.25 No.1

Trimethoprim-sulfamethoxazole (TMP-SMX) has been used for the treatment of urinary tract infections, but increasing resistance to TMP-SMX has been reported. In this study, we analyzed TMP-SMX resistance genes and their relatedness with integrons and insertion sequence common regions (ISCRs) in uropathogenic gram-negative bacilli. Consecutive nonduplicate TMP-SMX nonsusceptible clinical isolates of E. coli, K. pneumoniae, Acinetobacter spp., and P. aeruginosa were collected from urine. The minimal inhibitory concentration was determined by Etest. TMP-SMX resistance genes (sul and dfr), integrons, and ISCRs were analyzed by PCR and sequencing. A total of 45 E. coli (37.8%), 15 K. pneumoniae (18.5%), 12 Acinetobacter spp. (70.6%), and 9 Pseudomonas aeruginosa (30.0%) isolates were found to be resistant to TMP-SMX. Their MICs were all over 640. In E. coli and K. pneumoniae, sul1 and dfr genes were highly prevalent in relation with integron1. The sul3 gene was detected in E. coli. However, in P. aeruginosa and Acinetobacter spp., only sul1 was prevalent in relation with class 1 integron; however, dfr was not detected and sul2 was less prevalent than in Enterobacteriaceae. ISCR1 and/or ISCR2 were detected in E. coli, K. pneumoniae, and Acinetobacter spp. but the relatedness with TMP-SMX resistance genes was not prominent. ISCR14 was detected in six isolates of E. coli. In conclusion, resistance mechanisms for TMP-SMX were different between Enterobacteriaceae and glucose non-fermenting gram-negative bacilli. Class 1 integron was widely disseminated in uropathogenic gram-negative baciili, so the adoption of prudent use of antimicrobial agents and the establishment of a surveillance system are needed.

인간면역결핍바이러스 비감염자에서 발생한 주폐포자충 폐렴 환자군에서 trimethoprim-sulfamethoxazole의 투여 경로에 따른 효과 및 안전성 분석

오주영,이경아,김재송,손은선,박무석 한국병원약사회 2017 病院藥師會誌 Vol.34 No.3

Pneumocystis jiroveci pneumonia(PCP), caused by Pneumocystis jiroveci (P. jiroveci), is widespread in immunosuppressed patients. Oral trimethoprim-sulfamethoxazole (TMP-SMX) agents have a high bioavailability and economic benefits, whereas intravenous (IV) agents may result in fluid overload and electrolyte imbalance. Studies on tcost, differences in expected categories of safety could guide the clinician in preferentially choosing the oral administration route, particularly for patients with baseline renal or he effectiveness and safety analysis are insufficient, and most studies are subject to human immunodeficiency virus (HIV) infection status. This study compares the effectiveness and safety based on the route of administration of TMP-SMX, in PCP patients without HIV infection. We retrospectively reviewed 158 patients treated between 2013 and 2015, at the Yonsei University Health system. The therapeutic dose of TMP-SMX was administered for more than 14 days. Efficacy was evaluated by PCP polymerase chain reaction, six-month mortality, conversion rate to 2nd line therapy, ventilator weaning, PaO2/FiO2 ratio, fever and improvement. The safety was evaluated by electrolyte imbalance and fluid imbalance, hematologic side effects, renal, hepatic, and gastrointestinal intolerance, and skin rash occurrence. In 67(42.4%) cases, patients were administrated by the oral route, and 91(57.6%) patients received IV administration. The six-month mortality was significantly lower in the oral administration group (p 0.05). Also, the serum sodium, blood urea nitrogen and serum aspartate aminotransferase levels were significantly elevated in the IV administration group (p 0.05). No statistically significant differences were seen in other areas of comparison. In severe cases of PCP, physicians usually administered TMP-SMX through IV. The overall efficacy did not differ among the evaluated subset of patients without HIV infection, who received oral and IV TMP-SMX. In consideration of efficacy, safety and hepatic insufficiency or hyponatremia state. Subsequent large scale follow-up studies are required, to complement the limitations of this study.

Urosodeoxycholic Acid Therapy in a Child with Trimethoprim- Sulfamethoxazole-induced Vanishing Bile Duct Syndrome

Cho, Hyun Jeong,Jwa, Hye Jeong,Kim, Kyu Seon,Gang, Dae Yong,Kim, Jae Young The Korean Society of Pediatric Gastroenterology 2013 Pediatric gastroenterology, hepatology & nutrition Vol.16 No.4

We present a case of a 7-year-old boy who had cholestasis after trimethoprim-sulfamethoxazole combination therapy. Liver biopsy was performed 36 days after the onset of jaundice because of no evidence of improving cholestasis. Liver histology revealed portal inflammation, bile plug, and biliary stasis around the central vein with the loss of the interlobular bile ducts. Immunohistochemical stains for cytokeratin 7 and 19 were negative. These findings were consistent with those of vanishing bile duct syndrome (VBDS). Chlestasis was progressively improved with dose increment of urosodeoxycholic acid from conventional to high dose. This is the first case report of trimethoprime-sulfamethoxazole associated VBDS in Korean children. The case suggests that differential diagnosis of VBDS should be considered in case of progressive cholestatic hepatitis with elevation of alkaline phosphatase and gamma-glutamyl transpeptidase after or during taking medicine to treat nonhepatobiliary diseases illness.

류마티스관절염 환자에서 Trimethoprim-Sulfamethoxazole 사용 중 발생한 혈전성 혈소판감소자반증(Thrombotic Thrombocytopenic Purpura)

손지연 ( Ji Youn Sohn ),이경애 ( Kyung Ae Lee ),홍윤경 ( Yun Kyung Hong ),류완희 ( Wan Hee Yoo ) 대한류마티스학회 2009 대한류마티스학회지 Vol.16 No.4

Thromobotic thrombocytopenic purpura (TTP) is a multisystem disorder that`s characterized by consumptive thrombocytopenia, microangiopathic hemolytic anemia, and neurologic symptoms. TTP is associated with many diseases and several therapeutic drugs. We report here on the first Korean case of a patient with rheumatoid arthritis (RA) and who developed TTP that was associated with trimethoprim-sulfamethoxazole (TMP-SMX) in Korea. She recovered from the TTP following daily sessions of therapeutic plasma exchange (TPE) with fresh plasma replacement and glucocorticoid therapy. Awareness of the possible development of TTP in patient with RA and who is being treated with TMP-SMX is important for making the early diagnosis and administering proper treatment.

소아 급성림프구성백혈병 환자에서 Trimethoprim-Sulfamethoxazole과 Methotrexate 병용 투여 시 약물 부작용 평가

정원경,구현준,윤정이,강진숙 한국병원약사회 2023 병원약사회지 Vol.40 No.1

Background : As maintenance therapy for pediatric acute lymphoblastic leukemia (ALL), oral methotrexate (MTX) and mercaptopurine (6-MP) are administered to prevent relapses. In addition to these anticancer drugs, oral trimethoprim-sulfamethoxazole (TMP-SMX) is usually prescribed to reduce the risk of Pneumocystis jiroveci Pneumonia. However, concomitant use of MTX and TMP-SMX may result in an increase of toxicity of MTX. As a matter of fact, a new contraindication against the use of TMP-SMX with MTX has been announced by the Ministry of Health and Welfare in December 2020. The objective of this study was to evaluate adverse drug reactions associated with concomitant use of TMP-SMX and MTX in pediatric ALL. Methods : Sixty-five patients received a maintenance therapy between January 2016 and July 2021 at Seoul St. Mary’s Hospital. Patient’s medical records and histories from the beginning to the end of maintenance therapy were reviewed retrospectively. We analyzed each patient’s basic characteristics, incidence and severity of adverse drug reactions (myelotovicity, hepatotoxicity and nephrotoxicity), methotrexate (MTX) reduction or discontinuation according to adverse drug reactions and completion of maintenance therapy. Results : Incidence rates of chemotherapy cycles that have myelotoxicity, hepatotoxicity, and nephrotoxicity were 100%, 92.3%, and 63.1%, respectively. Majority (90.9%) of these adverse events fell into grade 1 or 2. All patients completed the maintenance therapy successfully. Conclusion : Despite recently announced contraindication against concomitant use of MTX and TMP-SMX, the maintenance therapy including both MTX and TMP-SMX for pediatric ALL patients might be safe when adverse drug reactions are carefully monitored.

임질의 항생제 병용 요법 - Kanamycin 과 Penicillin 병용 요법과 Kanamycin 과 Trimethoprim - Sulfamethoxazole 병용 요법의 비교 -

황규왕(Kyu Uang Whang),김재홍(Jae Hong Kim),김중환(Joong Hwan Kim) 대한피부과학회 1986 대한피부과학회지 Vol.24 No.5

From August to November 1985 244 bacteriologically proven male uncomplirated goncicoccal urethritis patients at the VD clinic of Choong-Ku Public Health Center form August to November 1985 were divided into group A and group B according to a random number sheet. In group A, treated with kanamycin 2.Ogm, im plus benzyl penicillin-G 5 mega units, im plus probenecid, 1.Ogm, PO; 112 of 121 patients were followed and 10 patients (8.9%) failed to be recovered. In group B, treated with kanamycin, 2,Ogm, im plus trimethoprim-sulfamethoxazole, 9 tahlets, PO; 112 of l23 patients were followed and 7(6.3%) failed. There is no sign.ificant difference between the two groups (p>0. 05) The failure rates in PPNG urethritis were 14.3% and 8.0% in group A and group B respectively. There is a signficant difference in failure rate between the two groups (P<0.05). It is suggested that, because of high rate of PPNG among circulating N.gonorrhoeae, the combinatioin regimen of kanamycin and trime.thoprim-sulfamethoxazole may be used as a first line treatrnent regimen for uncomplicated gonococcal urethritis

THE COMBINATION EFFECT OF SULFAMETHOXAZOLE AND TRIMETHOPRIM AGAINST ANIMAL INTESTINAL BACTERIA

Nakai, Y.,Matsumoto, H.,Ogimoto, K. Asian Australasian Association of Animal Productio 1991 Animal Bioscience Vol.4 No.3

Combination effects of sulfamethoxazole (SMX) and trimethoprim (TMP) against nine gram positive bacterial strains and 43 gram negative bacterial strains which included 40 strains of animal intestinal bacteria were studied in vitro. Minimum inhibitory concentrations (MICs) of SMX and TMP alone and 20:1 (SMX : TMP) mixture (ST) were investigated by the method recommended by Ad Hoc Committee of the Japan Society of Chemotherapy for the Evaluation of Sensitivity Testing Methods for Sulfamethoxazole and Trimethoprim. MICs of ST were more potentiated than those of SMX alone in 8 of 9 gram positive strains and 40 of 43 gram negative strains. Especially, 38 strains of 40 intestinal bacteria showed significant susceptibility to ST as compared to SMX. These results suggest a strong synergistic activity of ST mixture against animal intestinal bacteria, The activity was considered to be comparable to those of other current antibiotics.