Septrin and bactrim

Q:I would like to tell you about a side effect I suffered when taking Septrin for cystitis a number of years ago.

I became extremely depressed to the point of feeling desperate and suicidal. I had to choose between continuing with Septrin and feeling suicidal, or stopping Septrin and suffering the

agonies of cystitis. I chose the latter course, and simply stayed in bed, kept warm and drank masses of warm water. I very quickly regained my equilibrium and the cystitis went away, but it was a horrific experience.


Happily I have not had a recurrence; if I did I would consult my homeopathic doctor. J Y, Athens, Greece.......


A:About 10 years ago, I had a minor local infection and was prescribed Septrin. It made my urine cloudy and full of "bits". It cleared up about two weeks later, so I thought no more about it.

However, two and a half years ago I took a course of amoxycillin. It reminded me of the Septrin incident, because the effects were even more dramatic. There were so many tiny "crumbs" and "clots" floating about in my urine that it looked like pond water!

Since then, I have been plagued by repeated bladder infections, and a succession of antibiotics which have effectively ruined my gut.


Is there a way of avoiding and controlling bladder infections without antibiotics? J T, Ely, Cambs......


Septrin (Septra in the US) and Bactrim, known chemically as cotrimoxazole, commonly used for urinary tract infections, bronchitis, earache caused by bacterial infections, and traveller's diarrhea in adults, have been among the bestselling drugs of all times. Although usage is falling now, due to some bad publicity, they have enjoyed a revival among HIV positive patients as a "just in case" drug against Pneumocystis carinii pneumonia (PCP), associated with AIDS. And many doctors and dentists continue to prescribe it.

Cotrimoxazole resulted from an almost unheard of "marriage" of the products of two rival pharmaceutical companies, Wellcome and Hoffman-La Roche. According to Brian Deer, who published a large expose of Septrin/Bactrim in the Sunday Times (27 February 1994, Wellcome developed trimethoprim in 1957, an antibiotic that could rival penicillin, at a point when the drug company was relatively small. In order to launch the drug and maximize profits, executives decided tojoin forces with Roche by merging their drug with the Roche drug sulphamethoxazole.

However, according to the British Natural Formulary (1994), it is sulphamethoxazole, a sulphonamide, which has the most serious side effects: "There have been reports of deaths in patients over the age of 65 years being treated with cotrimoxazole and almost certainly associated with the sulphonamide component."

As the Physician's Desk Reference (1992/3) warns with Bactrim: "Fatalities associated with the administration of sulphonamides, although rare, have occurred due to severe reactions." These include Stevens-Johnson Syndrome (a condition of the skin and mucous membranes, with swelling, blistering and ulcers), toxic epidermal necrolysis (in which most of the body's skin becomes inflamed and the dead outer layer eventually strips off), death of liver tissue, agranulocytosis (lowering of white blood cells), aplastic anemia and other blood disorders.

Furthermore, says the BNF, although side effects of cotrimoxazole are similar to those of the sulphonamides, "a particular watch should be kept for [blood] effects and special care should be taken" in patients who are deficient in folic acid, such as the elderly and the chronic sick, and in those receiving "prolonged treatment or high doses". This has particular application for HIV patients given this drug as a just in case measure for PCP.

This is even more worrying when you consider that there is a kiddy version which is popularly given to children with acute earache. This is despite the fact Roche notes in the PDR with Bactrim, "To date, there are limited data on the safety of repeated use of Bactrim in children under two years of age."

The Sunday Times reported that at least 113 deaths linked to the sulphur based component have been reported by doctors to the Committee on the Safety of Medicines, a figure that may be only a tenth of the true total.

Recently, a UK group called Victims of Septrin formed in order to provide a support group for people allegedly damaged by the drug and to campaign for the drug's withdrawal outside the courts.

Besides the damage listed by the PDR, the group also says Septrin causes reactions to sunlight and skin rashes, heart and blood complaints, energy loss, muscle pains, food allergies all side effects they say they weren't warned of.

It's not surprising that our first correspondent suffered depression and the second the presence of what were probably crystals in the urine, since both are known side effects of the drug.

If you believe you have suffered similar side effects you can Victims of Septrin via 01494 523269.

Although the argument is that the dual drug is better for treating drug resistant strains of bacteria, there is evidence that it works no better than the safer trimethoprim alone. The Sunday Times reported that one study in the British Medical Journal (1972) demonstrated that trimethoprim had an identical cure rate as cotrimoxazole with "fewer than half the side effects." Indeed, the BNF also says that "trimethoprim alone is now preferred" for most infections except PCP.

Many other antibiotics can do the trick without these potentially lethal side effects. Otherwise, Beyond Antibiotics (North Atlantic Books, 2800 Woolsey St, Berkeley, California 94705 $16.95) offers some good natural alternatives. Our Alternatives columnist Harold Gaier has successfully treated many a recalcitrant infection, including those of the urinary tract, with tincture of Berberis.