Trimethoprim-Sulfamethoxazole and Acute Respiratory Failure in Adolescents and Young Adults

Is the use of trimethoprim-sulfamethoxazole (TMP-SMX) associated with an increased 30-day risk of hospital visits for acute respiratory failure among healthy adolescents and young adults compared with amoxicillin or cephalosporins?In this cohort study of adolescents and young adults aged 10 to younger than 25 years in Ontario, Canada, initiation of TMP-SMX was associated with a significantly higher 30-day risk of a hospital visit for acute respiratory failure compared with amoxicillin and cephalosporins. The absolute risk increase was small (0.02%) but consistent across sensitivity analyses.These findings support the US Food and Drug Administration’s warning regarding the risk of acute respiratory failure with TMP-SMX in healthy adolescents and young adults, and clinicians and regulators should carefully weigh this risk when prescribing TMP-SMX and consider updates to prescribing guidelines and product labeling.

Corresponding Author: Flory T. Muanda, MD, PhD, Department of Physiology and Pharmacology, Western University, Medical Sciences Building, 1151 Richmond St, Room 287, London, ON N6A 5C1, Canada (fmuandat@uwo.ca).

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