A 79 year old female living in a long term care facility was diagnosed  with a UTI.  Past medical history includes but not limited to urinary incontinence, hypertension, GERD, and osteoarthritis.  She has a past history of  nitrofurantoin and sulfa allergy.

This patient was initially put on ciprofloxacin to treat the infection.  With eventual review of culture and sensitivity reports, it was noted that the bacteria was resistant to ciprofloxacin.  The patient was transitioned from the ciprofloxacin to trimethoprim.

Within a day or two of the transition to the new antibiotic (trimethoprim), the patient begins to breakout in a rash affecting a significant portion of her body.  Upon investigation of past medical history, the patient had stated that she had taken Bactrim in the past and had a bad rash type reaction.  I suspect that this reaction was reported and documented as a sulfa allergy.  If you are anything like me, when I see a sulfa allergy, the first thing I think of is Bactrim (which contains sulfamethoxazole).  I don’t necessarily think of the trimethoprim component.  After this experience, it really emphasized to me the point that if a patient has an allergy to a specific medication, we need to document that.  Had the patient had sulfamethoxazole/trimethoprim listed as an allergy (or Bactrim), this would’ve had a better chance of being caught, or at least we’d have the opportunity to more closely monitor.

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