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Hematological side effects of co-trimoxazole

Hämatologische Nebenwirkungen von Co-trimoxazol

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Summary

Decrease of blood cells may be induced by either components of co-trimoxazole. Side effects of the trimethoprim component are much more frequent, particularly in risk groups. They are dose dependent, usually not severe, only rarely of clinical significance and easily treated or prevented by folate supplementation. In contrast, side effects of the sulfamethoxazole component seem to be extremely rare. They are similar to the hematological side effects of other sulfonamide drugs. They are idiosyncratic, nonpredictable and mostly mediated by the immune-system. They may be of life-threatening severity and no therapy is known except termination of exposure and supportive measures such as substitution of blood cells and antiinfectious therapy by non-related antibiotics.

Zusammenfassung

Beide Komponenten des Präparates „Co-trimoxazol“ können zu einer Veränderung des Blutbildes führen. Der Trimethoprim-Anteil verursacht jedoch wesentlich häufiger Zytopenien, insbesondere bei bestimmten Risikogruppen. Diese Nebenwirkungen sind dosisabhängig, gewöhnlich von leichter Form und daher nur selten von klinischer Bedeutung. Sie können durch Gabe von Fol-/Folinsäure verhindert bzw. behandelt werden. Demgegenüber sind Nebenwirkungen auf das Blutbild durch den Sulfamethoxazol-Anteil äußerst selten. Sie ähneln den bekannten Nebenwirkungen anderer Sulfonamidabkömmlinge. Diese Nebenwirkungen sind idiosynkratisch, nicht vorhersehbar und meistens immunmediiert. Es können Zytopenien von lebensbedrohendem Ausmaß auftreten, therapeutisch bleiben nur das sofortige Absetzen der Substanz sowie entsprechende supportive Maßnahmen wie z. B. Gabe von Blutkomponenten oder antibiotische Therapie mit nicht verwandten Pharmaka.

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Heimpel, H., Raghavachar, A. Hematological side effects of co-trimoxazole. Infection 15 (Suppl 5), S248–S253 (1987). https://doi.org/10.1007/BF01643198

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