trimethoprim/sulfamethoxazole / Generic mfg. - LARVOL DELTA

LESSISMORE: A study to determine if a lower dose of the antibiotic trimethoprim/sulfamethoxazole will result in the same clinical cure and fewer side effects as the currently recommended higher dose of trimethoprim/sulfamethoxazole for the treatment of adults with melioidosis. (ANZCTR) - P4 | N=128 | Recruiting | Sponsor: Cairns Hospital | Not yet recruiting ➔ Recruiting | Initiation date: Jan 2026

Adverse events • Enrollment open • Trial initiation date

Potential clinical implications due to essential differences in antimicrobial susceptibility profiles of actinomycetoma causative agents of the Actinomadura, Nocardia and Streptomyces genera towards commonly used anti-actinomycetoma drugs. (PubMed, J Antimicrob Chemother) - "Clear differences in antimicrobial susceptibility patterns were noted for the different actinomycetoma causative agents, indicating that actinomycetoma treatment should be tailored to the causative agent."

Journal • Oncology

Genomic epidemiology of Salmonella Typhimurium in Guizhou, China (2019-2023): high prevalence of MDR, plasmid-associated resistance, and shared genomic lineages. (PubMed, Front Microbiol) - "Substantial resistance to first-line antibiotics was also observed, including ciprofloxacin (16.5%), ceftazidime (19.4%), cefotaxime (36.9%), and azithromycin (12.6%)...Resistance genotypes correlated well with phenotypes for azithromycin, ceftazidime, ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, and tetracycline (Kappa: 0.48-0.74)...These findings highlight the cross-regional and cross-species circulation of shared genomic lineages, suggesting complex ecological networks that may involve the food supply chain. Implementing an integrated "One Health" surveillance strategy is critical to track and limit the circulation of these resistant lineages and mitigate the associated public health threat."

Journal • Gastroenterology • Gastrointestinal Disorder

Challenges in establishing epidemiological cut-off values for the Burkholderia cepacia complex. (PubMed, J Clin Microbiol) - "Here, we present an analysis of BCC ECVs for ceftazidime (CAZ), levofloxacin (LVX), meropenem (MEM), minocycline (MIN), and trimethoprim-sulfamethoxazole (TMP-SMX). Additionally, we encountered significant challenges in our analyses, including data limitations for these organisms and high ECVs that are not clinically useful. These challenges limit the practical use of these ECVs in helping guide treatment and support the removal of ECVs from the CLSI M100 standards document."

Journal • Infectious Disease

Application of digital pathology to assess the effect of hormone treatment on placental histomorphometry in mares with induced ascending placentitis. (PubMed, Theriogenology) - "Thirty pregnancies from 27 Criollo-type mares were assigned to six groups: healthy controls (n = 5); basic treatment (n = 5), treated with trimethoprim-sulfamethoxazole (TSM), and flunixin meglumine (FM); ALT group (n = 5) + basic treatment; ECP group (n = 5) + basic treatment; ALT + ECP group (n = 5) in addition to basic treatment; and an untreated placentitis group (n = 5). The findings support the therapeutic potential of ECP in promoting placental recovery and maintaining uterine homeostasis. Additionally, this study highlights the utility of digital pathology in the quantitative assessment of equine placental morphology, providing new perspectives for improving therapeutic strategies in the management of placentitis."

Journal

Prevalence of ESBL-associated resistance genes and antimicrobial resistance in Escherichia coli from pigs and cattle slaughtered at urban abattoirs in Lilongwe District, Malawi. (PubMed, Front Vet Sci) - "Antimicrobial susceptibility testing was performed by disk diffusion (CLSI) against gentamicin, chloramphenicol, ciprofloxacin, sulfamethoxazole-trimethoprim, cefotaxime, and tetracycline. These results provide an initial baseline for monitoring E. coli harboring targeted ESBL-associated genes at the livestock-food chain interface in Malawi. While stewardship practices were not directly assessed, the findings raise important implications for species-stratified antibiotic stewardship and highlight the value of systematic antimicrobial resistance monitoring within a One Health framework."

Journal

When Abdominal Pain Persists: An Atypical Presentation of IgA Vasculitis (ACG 2026) - "Case Description/ A 56-year-old male with PE on warfarin, positive anticardiolipin antibodies, COPD, hypothyroidism, OSA, and sporadic NSAID use presented with two weeks of progressive abdominal pain, early satiety, nausea, vomiting, and food aversion following presumed food poisoning...Prednisone 60 mg daily produced prompt improvement; the patient was discharged on a taper, with PPI and Bactrim prophylaxis, and achieved near-complete resolution at four-week follow-up...Endoscopic stellate ulcerations with diffuse erythema and early skin biopsy demonstrating LCV are critical diagnostic tools. This case underscores the importance of integrating GI, dermatologic, and rheumatologic findings and initiating systemic corticosteroids promptly in adults with GI-predominant IgAV to prevent ischemic and hemorrhagic complications."

Chronic Obstructive Pulmonary Disease • Crohn's disease • Endocrine Disorders • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Immunology • Inflammatory Bowel Disease • Pain • Respiratory Diseases • Thrombocytosis • Vasculitis

The Great Hepatic Mimicker: Hepatic Sarcoidosis Masquerading as TMP-SMX-Induced Cholestatic Liver Injury (ACG 2026) - "She was started on prednisone and TMP-SMX for Pneumocystis jirovecii prophylaxis...The patient was treated with high-dose corticosteroids and ursodeoxycholic acid...Early recognition is important because delayed diagnosis may result in progressive liver dysfunction and the need for liver transplantation. Figure: Progressive elevation of bilirubin and alkaline phosphatase despite withdrawal of TMP-SMX in biopsy-confirmed hepatic sarcoidosis."

Autoimmune Hepatitis • Cholestasis • Gastroenterology • Hepatology • Immunology • Inflammation • Liver Failure • Pulmonary Disease • Sarcoidosis

Donor-Derived Disseminated Toxoplasmosis After Liver Transplant (ACG 2026) - "He was empirically treated with meropenem and micafungin...Atovaquone should be considered as a second line option for patients at risk of toxoplasmosis who cannot tolerate TMP-SMX due to its activity against both Toxoplasma and Pneumocystis . Figure: Table 1: Infection status of donor and recipient prior to transplant. Figure: Table 2: Results of initial infectious laboratory workup."

Cholestasis • Fibrosis • Hepatology • Immunology • Infectious Disease • Liver Failure • Nephrology • Renal Disease • Septic Shock • Transplantation

Rare Esophageal Involvement of Post-Transplant Lymphoproliferative Disorder (ACG 2026) - "Case Description/ A 70 year-old male with a history of pulmonary fibrosis and pulmonary hypertension status post lung transplant on tacrolimus, valacyclovir and sulfamethoxazole/trimethoprim, presented with hematochezia. He was recently diagnosed with PTLD, and was also on rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP)...B: Mucosa suggestive of Barrett's with nodule. C: Ulcerated mucosa in the terminal ileum."

Post-transplantation • Barrett Esophagus • Cardiovascular • Epstein-Barr Virus Infections • Gastrointestinal Disorder • Hematological Malignancies • Hypotension • Immunology • Lymphoma • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases • T Cell Non-Hodgkin Lymphoma • Transplantation

Shigella Flexneri Proctocolitis Masquerading as Inflammatory Bowel Disease in a Young Adult With Newly Diagnosed HIV-1 Infection (ACG 2026) - "Post-discharge, stool culture finalized as S. flexneri resistant to ampicillin and TMP-SMX. Therapy was switched to ciprofloxacin with clinical resolution...Misclassification as LGV is well documented, as both produce proctocolitis with bleeding and rectal inflammation. This case reinforces the need for stool cultures, comprehensive STI screening, and attention to resistance patterns in MSM populations presenting with severe proctocolitis."

Clinical • Cardiovascular • Colorectal Cancer • Crohn's disease • Gastroenterology • Gastrointestinal Disorder • Heart Failure • Hepatology • Human Immunodeficiency Virus • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • CD4

Whipple's Disease With CNS Involvement (ACG 2026) - "Based on these findings and social considerations, the patient was discharged on oral doxycycline and hydroxychloroquine...He was later transitioned to complete intravenous ceftriaxone for a total of 14 days, followed by trimethoprim sulfamethoxazole with planned 12-month therapy...Histiocytes showing granular positivity with this OAS-D stain, consistent with Whipple's disease. D: Endoscopic View of second portion of duodenum 6-months into treatment with improving inflammation."

CNS Disorders • Gastrointestinal Disorder • Hematological Disorders • Immunology • Infectious Disease • Inflammation • Musculoskeletal Pain

Steroid-Refractory Immune Checkpoint Inhibitor (ICI) Hepatitis Presenting With DRESS-Like Features: A Diagnostic and Therapeutic Challenge (ACG 2026) - "Case Description/ A previously healthy 21-year-old Caucasian male with stage IIIb Hodgkin lymphoma was treated with ABVD chemotherapy followed by brentuximab and nivolumab. He developed a perirectal abscess, treated with Bactrim and Augmentin...He was discharged on a 4-week prednisone taper...Despite initiating N-acetylcysteine, IV steroids, and empiric antivirals, his liver enzymes worsened (peak AST/ALT >2,000 U/L and Bilirubin >3mg/dL)...Given the temporal association with ICI exposure, steroid refractory ICI hepatitis was diagnosed, and mycophenolate mofetil 1000mg twice daily was initiated with rapid normalization of liver enzymes...A cytokeratin 7 immunohistochemical was used to highlight native bile ducts and focal ductular reaction. Additional immunohistochemical stains for cytomegalovirus and herpes simplex virus 1/2 and Epstein-Barr Virus-Encoded Small RNAs (EBER) in situ hybridization were negative."

Checkpoint inhibition • Autoimmune Hepatitis • Cholestasis • Cytomegalovirus Infection • Eosinophilia • Epstein-Barr Virus Infections • Fibrosis • Hematological Malignancies • Hepatology • Herpes Simplex • Hodgkin Lymphoma • Immunology • Inflammation • Liver Failure • Lymphoma • Oncology • Vasculitis

Rare Case of Salmonella Bacteremia Mimicking Severe Sepsis With Pulmonary Embolism in a Traveler (ACG 2026) - "Blood cultures later grew Salmonella species sensitive to ceftriaxone and trimethoprim-sulfamethoxazole. The patient required ICU admission and treatment with intravenous heparin followed by apixaban, along with targeted antimicrobial therapy...This confirms the diagnosis of acute pulmonary embolism Figure: CT scan of the chest in lung window demonstrates wedge-shaped infarction. These findings are compatible with segmental pulmonary emboli"

Clinical • Cardiovascular • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Infectious Disease • Inflammation • Malaria • Pulmonary Embolism • Respiratory Diseases • Septic Shock • Thrombocytopenia • Venous Thromboembolism

A Challenging Case of Trimethoprim Sulfamethoxazole-Associated Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) With Prominent Hepatic Involvement and an Atypical Rash (ACG 2026) - "(C) Liver core biopsy shows portal tracts expanded by inflammatory infiltrate with mild interface activity and lobular disarray with sinusoidal inflammation (×100). (D) Mixed portal inflammation includes lymphocytes, histiocytes, and eosinophils; interlobular bile duct (arrowhead) shows epithelial damage and inflammatory infiltration (×200)."

Clinical • Dermatitis • Eosinophilia • Hepatology • Human Immunodeficiency Virus • Immunology • Infectious Disease • Inflammation • Liver Failure • Pneumonia • Respiratory Diseases • CD4

A Diagnostic Challenge in Activated PI3K-Delta Syndrome: Multisystem Inflammatory and Infectious Mimicry (ACG 2026) - "Case Description/ A 50 year old female from the Dominican Republic with APDS 2 on IgG and leniolisib history of childhood toxoplasmosis recurrent sinopulmonary infections mastoiditis otitis media and duodenal ulcer disease presented with 4 days of fever night sweats diffuse abdominal pain and 2 days of diarrhea.She previously required hospitalization for GBS pharyngitis with bacteremia complicated by abdominal pain submandibular swelling odynophagia diarrhea and hematochezia...She was treated with IV acyclovir fluconazole and Bactrim prophylaxis...Broad differential diagnosis and multidisciplinary management are essential when standard diagnostics remain unrevealing. Figure: Upper GI tract nasopharynx/oropharynx abnormal Figure: lower third of the esophagus and GE junction"

Candidiasis • Crohn's disease • Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Otorhinolaryngology • Peptic Ulcer • Primary Immunodeficiency • Respiratory Diseases • PIK3CD

The Great Mimicker in the Gut: A Patient-Level Systematic Review of Gastrointestinal Malakoplakia 1965 to 2026 (ACG 2026) - "Fluoroquinolones (47.0%) and trimethoprim-sulfamethoxazole (24.1%) were the antibiotics used for treatment... Median age was 55 years; 167/194 (86.1%) were adults and 121/193 (62.7%) had male sex. Among those with immune status reported, 94/133 (70.7%) were immunocompromised, including 31 transplant recipients; malignancy was present in 61/129 (47.3%). Disease was predominantly colorectal: rectum (38.5%), sigmoid (21.4%), cecum (18.8%) and multifocal in 62.8%."

Clinical • Review • Colorectal Cancer • Gastroenterology • Gastrointestinal Disorder • Immunology • Inflammatory Bowel Disease • Rare Diseases • Solid Tumor

Persistent Recurrent ESBL Escherichia coli Bacteremia Following Transjugular Intrahepatic Portosystemic Shunt (TIPS) Placement: Presumed EndoTIPSitis (ACG 2026) - "Within days of TIPS placement, he developed polymicrobial bacteremia with vancomycin-resistant Enterococcus (VRE) and extended-spectrum beta-lactamase (ESBL) Escherichia coli , treated with IV daptomycin and meropenem (11/27-12/10)...The patient was treated with six weeks of IV ertapenem followed by indefinite suppressive trimethoprim-sulfamethoxazole therapy, resulting in resolution of fevers and clearance of bacteremia...Recurrent bacteremia with enteric pathogens following TIPS placement â particularly with repeated relapse despite appropriate antimicrobial therapy â should prompt consideration of endoTIPSitis after alternative sources are excluded. Because TIPS removal is generally not feasible, management may require prolonged antimicrobial therapy, chronic suppressive treatment, and consideration of liver transplantation for definitive source control."

Fibrosis • Gastroenterology • Hepatology • Immunology • Infectious Disease • Thrombosis

Is Decompensated Cirrhosis an Independent Risk Factor for the Development of PJP Pneumonia? A Case Report (ACG 2026) - "She was started on TMP-SMX and a prednisone taper. 2025 Jul 3;11(7):500. doi: 10.3390/jof11070500."

Case report • Clinical • Fibrosis • Hematological Disorders • Hepatology • Immunology • Infectious Disease • Inflammation • Pneumonia • Pulmonary Disease • Respiratory Diseases • Type 2 Diabetes Mellitus

Renal and Colonic Malakoplakia Mimicking Metastatic Cancer in a Patient on Long-Term Immunosuppression for Rheumatoid Arthritis (ACG 2026) - "Case Description/ A 68-year-old woman with RA on prednisone, methotrexate, and hydroxychloroquine, and pulmonary embolism (PE) on apixaban, presented with two weeks of flu-like symptoms and urinary frequency. Management begins with reducing immunosuppression and macrophage-penetrating antibiotics such as trimethoprim-sulfamethoxazole or fluoroquinolones, with surgery reserved for mass effect or failure of medical therapy. Figure: A. Renal parenchyma (on right side) B. Higher power view of A showing histiocytic inflammation C. + CD68 immunostain marker of histiocytes and macrophages D. Negative AE1/AE3 immunostain arguing against carcinoma E. CT scan illustrating renal mass with colonic involvement F. Diverticulum with ulcerated mucosa G. Panned out view of descending colon diverticulum H. Inside the ulcerated diverticular defect"

Clinical • Metastases • Acute Kidney Injury • Gastrointestinal Disorder • Immunology • Inflammatory Arthritis • Nephrology • Oncology • Pulmonary Embolism • Renal Cell Carcinoma • Renal Disease • Respiratory Diseases • Rheumatoid Arthritis • Rheumatology • Urology • CD68 • KIT

Gastrointestinal Kaposi Sarcoma: An Underdiagnosed Manifestation of Advanced HIV (ACG 2026) - "He was diagnosed with Pneumocystis jirovecii pneumonia and disseminated histoplasmosis and was treated with trimethoprim-sulfamethoxazole and voriconazole...Biopsies confirmed GI-KS, and he was started on bictegravir/emtricitabine/tenofovir alafenamide and doxorubicin for advanced KS...F. Normal-appearing duodenum."

Metastases • Cardiovascular • Epstein-Barr Virus Infections • Gastrointestinal Disorder • Hematological Disorders • Human Immunodeficiency Virus • Infectious Disease • Kaposi Sarcoma • Pneumonia • Pulmonary Disease • Respiratory Diseases • Sarcoma • Septic Shock • Solid Tumor • CD4

Beyond Perforation: Spontaneous Pneumoperitoneum With Pneumatosis Intestinalis in the Setting of SIBO (ACG 2026) - "A two-week course of trimethoprim-sulfamethoxazole plus neomycin resulted in marked symptomatic improvement and substantial radiographic resolution of pneumoperitoneum...X-ray demonstrating free air Figure: Figure 2. CT showing pneumoperitoneum"

Gastroenterology • Gastrointestinal Disorder • Immunology • Inflammation • Inflammatory Bowel Disease • ELANE

Persistent Biliary Cholestasis Due to Eosinophilic Cholangitis: A Manifestation of Drug-Induced Liver Injury (DILI) (ACG 2026) - "She required mechanical ventilation for hypoxic respiratory failure and received intravenous(IV) Vancomycin, Piperacillin and Tazobactam, Doxycycline, and steroids for pneumonia, septic shock and COPD exacerbation. A treatment dose of IV Trimethoprim-Sulfamethoxazole (TMP-SMX) 800/160 mg twice daily was started and discontinued after 5 days due to cholestatic transaminitis with rising bilirubin levels...She received ursodeoxycholic acid 13mg/kg/d for 3 weeks as well as a trial of oral prednisone 40 mg for 7 days...Persistent cholestasis after adequate biliary decompression should prompt early DILI evaluation, liver biopsy, and monitoring for progression to Vanishing bile duct syndrome. Figure: Table 1 shows Laboratory investigations Abbreviations: ERCP: endoscopic retrograde cholangiopancreatography; HGB: Hemoglobin; WBC: White Blood Cell; ALT: Alanine Aminotransferase; AST: Aspartate Aminotransferase; ALP: Alkaline Phosphatase; GGT- gamma-glutamyl transferase; TB: Total..."

Cholestasis • Chronic Obstructive Pulmonary Disease • Eosinophilia • Genetic Disorders • Hepatology • Human Immunodeficiency Virus • Immunology • Infectious Disease • Liver Failure • Obesity • Pneumonia • Pulmonary Disease • Respiratory Diseases • Septic Shock

Beyond the Peritoneum: A Case of Subcutaneous Ascites Following Paracentesis (ACG 2026) - "He was maintained on trimethoprim-sulfamethoxazole which was previously prescribed for secondary SBP prophylaxis...Although rare, recognition of this complication is crucial as it can mimic peritonitis or cellulitis on imaging. Figure: CT imaging findings Figure: CT imaging findings"

Clinical • Fibrosis • Gastrointestinal Neuroendocrine Tumor • Hepatology • Immunology • Neuroendocrine Tumor • Solid Tumor

When Treatment Turns Toxic: A Case of TMP-SMXâInduced Acute-on-Chronic Liver Failure (ACG 2026) - "Establishing causality relies heavily on exclusion of competing etiologies and recognition of characteristic patterns following drug exposure. This case highlights the need for careful medication management in patients with pre-existing cirrhosis, as even transient hepatic insults may precipitate acute-on-chronic liver failure."

Clinical • Bipolar Disorder • CNS Disorders • Fibrosis • Hepatology • Immunology • Infectious Disease • Liver Failure • Metabolic Disorders • Metabolic Dysfunction-Associated Steatohepatitis • Nephrology