Lupus and Bactrim: List sulfa antibiotics (like Bactrim) in your allergy list if you have lupus
Lupus patients are more likely to have allergies to antibiotics (plus, lupus and Bactrim are a bad combination)
While lupus and Bactrim are a bad combination, many systemic lupus erythematosus (SLE) patients also report numerous drug allergies. However, studies do not show an increased amount of allergies than non-lupus patients (other than antibiotics).
Lupus and antibiotics treatment:
SLE patients have higher rates of allergies and intolerances to penicillins, cephalosporins, sulfonamides, and the antibiotic erythromycin. The most important antibiotic intolerance is that of sulfonamide (often called “sulfa”) antibiotics. This most commonly refers to the antibiotic trimethoprim-sulfamethoxazole (Bactrim and Septra).
Sulfur versus sulfonamides versus other sulfa drugs and lupus
The element called sulfur exists in all of us, so none of us are allergic to sulfur. Many different molecules contain sulfur to include sulfates, sulfites, and sulfonamides. Lupus patients have an increased risk of antibiotic sulfonamides (specifically Bactrim, trimethoprim-sulfamethoxazole) flaring their lupus. Sulfonamide antibiotics are very different than sulfates, sulfites, and others. These are safe for lupus patients to take. There are some non-antibiotic sulfonamides (furosemide, hydrochlorothiazide, acetazolamide, sulfonylureas used for diabetes, and celecoxib). However, these do not appear to increase lupus flares and are safe for lupus patients to take (unless they just happen to have an allergy to that particular drug).
Sulfa antibiotics can cause significant lupus flares (list is as an allergy!)
Around one-third of lupus (SLE) patients have reactions to Bactrim, and it can cause lupus flares as well. These reactions are more common in Caucasians, those with low lymphocyte counts (lymphopenia), and anti-SSA positive patients. Still, they can occur in any lupus patient. They especially can cause flares of fever, sun-sensitive rashes, and low blood cell counts. Sometimes these flares can be severe. There are so many other antibiotics now available that sulfonamide antibiotics can usually be avoided in SLE patients.
I, and most lupus experts, recommend that all lupus patients always carry an up-to-date medication list (similar to the first image, above) and that it also includes an allergy list that includes “sulfa antibiotics.” This can protect you if you ever get sick and end up in the emergency room where it can be hard to remember to tell your entire medical history. While lupus patients are more likely to be intolerant of the antibiotics penicillin, cephalosporins, and erythromycin, these do not typically cause lupus flares, and the vast majority of SLE patients tolerate them well. Therefore, they do not need to be avoided in lupus patients who are not allergic to them.
Patient Question: “Can you take amoxicillin if you have lupus?”
“Yes!” The good news is that we have dozens of other safe antibiotics that lupus patients can take. Lupus and antibiotics treatment should not be complicated. As long as you list “sulfa antibiotics” on your drug intolerance list and show it to doctors, they can come up with safe alternatives. Although lupus and Bactrim are a bad idea, lupus patients can take many other medications safely.
The Lupus Secrets
PLEASE SHARE THIS POST WITH OTHER LUPUS PATIENTS … HELP GET THE WORD OUT!
Background of “The Lupus Secrets“:
I regularly update this list as our knowledge of lupus improves. The Lupus Secrets list is given to all my patients, and encourage them to follow it. Most of my SLE patients are in remission or low disease activity, and I care for many people with SLE. My patients’ utilization of “The Lupus Secrets” is an important tool in achieving this goal. Please download a copy. Each recommendation has medical literature to back it up (check out the references below for this “Secret”), though each varies in the strength of evidence.
Don Thomas, MD
Author of The Lupus Encyclopedia
Petri, M, Allbritton, J. Antibiotic allergy in systemic lupus erythematosus: a case-control study. J Rheumatol 1992; 19: 265–269.
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