Rapid Desensitisation of an Immunocompetent Patient with Cotrimoxazole Hypersensitivity

Abstract

ABSTRACTBackgroundHypersensitivity reactions to cotrimoxazole (trimethoprim+sulfamethoxazole) are common. Limited and varied data are available on desensitisation protocols for patients with cotrimoxazole hypersensitivity.AimTo report the successful rapid desensitisation of an immunocompetent patient with cotrimoxazole hypersensitivity.Clinical DetailsA 58‐year‐old male presented with multiple brain abscesses of unknown origin on a background of actinomycotic lung lesions. He was admitted to the intensive care unit in a critical state and started on multiple antibiotics. After limited clinical improvement intravenous cotrimoxazole was initiated. Although the patient's clinical signs improved, he developed a rash. Cotrimoxazole was ceased and the rash cleared. Once the patient was clinically stable, cotrimoxazole desensitisation was attempted over 6 hours using the protocol from Therapeutic Guidelines: Antibiotic.OutcomesThe patient was successfully desensitised and subsequently completed a 6‐month course of cotrimoxazole therapy. No further adverse reactions were reported.ConclusionCotrimoxazole desensitisation using the protocol from Therapeutic Guidelines: Antibiotic can allow treatment of patients with sulfamethoxazole hypersensitivity.