Can Bactrim (Trimethoprim/Sulfamethoxazole) cause cough and dyspnea?

From the Guidelines

Yes, Bactrim (sulfamethoxazole-trimethoprim) can cause cough and shortness of breath as side effects, though these symptoms may indicate a serious adverse reaction that requires immediate medical attention. Respiratory side effects from Bactrim are relatively uncommon but potentially serious. Non-productive cough occurs in less than 3% of patients taking the medication. However, shortness of breath can be a symptom of a more severe hypersensitivity reaction or pulmonary toxicity, which occurs in approximately 0.5-1% of patients. These respiratory symptoms are particularly concerning as they may indicate the development of acute pulmonary hypersensitivity or, rarely, a condition called eosinophilic pneumonia. Patients who experience new or worsening cough or any difficulty breathing while taking Bactrim should stop the medication and seek immediate medical care, as these symptoms can progress rapidly. People with asthma or other respiratory conditions may be at higher risk for these side effects. The mechanism behind these reactions involves an immune-mediated hypersensitivity to the sulfonamide component of the drug, which can trigger inflammation in the lungs and airways. According to the most recent study 1, the American College of Physicians recommends limiting antibiotic treatment duration to 5 days when managing patients with COPD exacerbations and acute uncomplicated bronchitis who have clinical signs of a bacterial infection. However, this study does not specifically address the side effects of Bactrim, but it highlights the importance of careful consideration of antibiotic use and monitoring for potential adverse reactions. In the context of real-life clinical medicine, it is essential to prioritize caution and consider the potential risks and benefits of Bactrim treatment, particularly in patients with pre-existing respiratory conditions. Key points to consider include:

• Monitoring for respiratory side effects, such as cough and shortness of breath
• Stopping the medication and seeking immediate medical care if symptoms worsen or progress rapidly
• Considering alternative antibiotic options or adjusting treatment duration based on individual patient needs and response to therapy.

From the FDA Drug Label

Cough, shortness of breath and pulmonary infiltrates potentially representing hypersensitivity reactions of the respiratory tract have been reported in association with sulfamethoxazole and trimethoprim treatment Clinical signs, such as rash, pharyngitis, fever, arthralgia, cough, chest pain, dyspnea, pallor, purpura or jaundice may be early indications of serious reactions.

Yes, Bactrim (Trimethoprim/Sulfamethoxazole) can cause cough and dyspnea as part of a hypersensitivity reaction or other serious adverse reactions. Key points include:

• Hypersensitivity reactions of the respiratory tract have been reported
• Cough and dyspnea are listed as potential clinical signs of serious reactions
• These reactions can be severe and potentially life-threatening 2

From the Research

Bactrim (Trimethoprim/Sulfamethoxazole) and Respiratory Symptoms

• Bactrim, a combination of trimethoprim and sulfamethoxazole, is a commonly used antibiotic that can cause various side effects, including respiratory symptoms such as cough and dyspnea 3.
• A case report published in 2023 described a rare instance of trimethoprim-sulfamethoxazole-induced lung injury in an eight-year-old child, which presented with symptoms of shortness of breath, fever, and maculopapular rash 3.
• Another study published in 2020 found that co-trimoxazole (trimethoprim-sulfamethoxazole) did not reduce the risk of death, lung transplant, or hospital admission in patients with moderate and severe idiopathic pulmonary fibrosis, and did not have a significant effect on cough severity or other patient-reported outcomes 4.

Mechanism and Prevalence

• The exact mechanism of trimethoprim-sulfamethoxazole-induced lung injury is not well understood, but it is thought to be related to an allergic reaction or hypersensitivity to the drug 3.
• The prevalence of respiratory symptoms such as cough and dyspnea in patients taking trimethoprim-sulfamethoxazole is not well established, but it is considered a rare side effect 3, 4.
• Other studies have found that trimethoprim-sulfamethoxazole can be effective in treating certain respiratory infections, such as exacerbations of chronic bronchitis and pneumonia 5.

Diagnosis and Management

• Diagnosis of trimethoprim-sulfamethoxazole-induced lung injury can be challenging, and requires a thorough evaluation of the patient's symptoms and medical history 3.
• Management of the condition typically involves discontinuation of the offending drug and treatment with corticosteroids, although the effectiveness of this approach has not been well established 3, 4.
• Patients with idiopathic pulmonary fibrosis who experience respiratory symptoms such as cough and dyspnea while taking trimethoprim-sulfamethoxazole should be closely monitored and evaluated for other possible causes of their symptoms 6, 4.