In patients with SLE do you have concerns about using trimethoprim-sulfamethoxazole (Bactrim) because of a potential risk of lupus flare?

I agree with Dr. @Dr. First Last . I have had too many SLE patients over the years show up in my office with a severe flare from TMP/SMX. We have too many alternative antibiotics these days, including for PJP prophylaxis, so sulfonamide antibiotics should be avoided in SLE patients.

The typical scen...

I have had two patients hospitalized with lupus flares after being placed on TMP/SMX by ER physicians, and two others who had diffuse skin eruptions. The med residents who saw the flares and cared for the patients in the hospitals told me how impressed they were with the flares.

The other important thing to consider is whether your patient with SLE really needs PJP prophylaxis. I have seen multiple patients admitted to the hospital with dapsone-induced methemoglobinemia or milder adverse reactions to TMP/SMX. Studies have demonstrated low rates of PJP in SLE, even in patien...

The data regarding this is decades old that Bactrim can lead to a lupus flare. No definitive studies were done and we have all had patients that Bactrim was the best antibiotic choice for them and they did not flare. Perhaps enhancing sun sensitivity may be part of the story. If there is an alternat...

Yes, I have some concern, mainly because patients with SLE appear to have a higher rate of adverse reactions to TMP-SMX, particularly rash and cytopenias, and these reactions can sometimes mimic or coincide with a lupus flare. However, I do not consider SLE itself a contraindication to Bactrim. If t...