Trimethoprim-Sulfamethoxazole-Induced Aseptic Meningitis: A New Approach

Abstract

Inflammation of the meningeal linings of the central nervous system (CNS), also known as meningitis, is one of the serious presentations in the emergency because it carries high morbidity and mortality. The most common cause is pus-producing organisms. However, non-suppurative meningitis, termed aseptic meningitis, is another cause of meningeal inflammation. Many etiologies stand behind aseptic meningitis. Those etiologies include viral and non-viral, drug-induced, malignancy, and systemic inflammation. Druginduced aseptic meningitis is a rare type of meningitis. Although it is easily treated, it can be a challenging disease if not present in the differential diagnosis. It is commonly associated with nonsteroidal antiinflammatory drugs (NSAIDs). Nonetheless, other medications have been also reported to cause aseptic meningitis, including antibiotics. Trimethoprim-sulfamethoxazole (TMP-SMX) is one of the most prescribed antibiotics as a prophylactic and therapeutic drug due to its effectiveness and low cost. Although immunocompromised patients are at a higher risk to develop aseptic meningitis, immunocompetent patients are also at risk. Unrelated to the source of the infection, TMP-SMX carries a risk of aseptic meningitis and should be considered as an etiology in patients presenting with meningeal signs and symptoms. Hereby, we report a young immunocompetent patient who developed aseptic meningitis eight days after being prescribed TMP-SMX. Like all drug-induced aseptic meningitis, all his symptoms resolved two days after stopping the medication.

The Blood–Brain Barrier and Pharmacokinetic/Pharmacodynamic Optimization of Antibiotics for the Treatment of Central Nervous System Infections in Adults

“…TMP-SMX has desirable antimicrobial activity against common Gram-negative pathogens, such as Enterobacter , Acinetobacter , and Serratia , as well as Gram-positive pathogens, such as Staphylococcus aureus and Listeria monocytogenes , that can cause meningitis, and which may be only moderately susceptible or resistant to third generation cephalosporins [ 184 ]. It is important to note that TMP-SMX has a well-documented risk of causing drug-induced aseptic meningitis and is the most commonly reported antibiotic cause of this condition [ 185 ]. This risk is higher among immunocompromised patients but is also seen in immunocompetent individuals.…”

A Pediatric Case of Trimethoprim/ Sulfamethoxazole Associated Aseptic Meningitis

“…It seems there is a relationship between prior exposure to the drug and faster development of ASM [5,6]. Diagnosis is generally accepted when there is complete recovery of all symptoms within 2 -14 days of discontinuation of the suspected drug [1,4]. Other proposed diagnostic methods include controlled re-exposure to the drug in a medical setting [1], but there are potentially fatal consequences to this.…”

Trimethoprim-sulfamethoxazole induced aseptic meningitis case report

“…Although this type of meningitis is easily treated with the discontinuation of the causative drug, the diagnosis remains a big challenge for physicians, as it remains a diagnosis of exclusion. [ 1 , 14 , 15 ]…”

“…Although this type of meningitis is easily treated with the discontinuation of the causative drug, the diagnosis remains a big challenge for physicians, as it remains a diagnosis of exclusion. [1,14,15] This case report underlines how an antimicrobial stewardship program with a strict monitoring of patients by infectious disease specialists is essential, not only to optimize the appropriate use of antimicrobials decreasing the emergence and spread of multidrug-resistant infections, but also to improve patient outcomes and reduce the likelihood of adverse events. [16][17][18]…”