Trimethoprim-Sulfamethoxazole, commonly known as Bactrim, is widely prescribed in the U.S. for treating various conditions including mild chest infections, bacterial infections, and acne. While generally considered effective, medical professionals are now raising concerns about rare but severe reactions to this widely-used antibiotic.
A Young Patient’s Struggle

The severity of these reactions is starkly illustrated by the case of twelve-year-old Emmie Bellucci from Texas. Prescribed the antibiotic Bactrim twice for cystic acne, Emmie experienced an extreme reaction that led to complete lung failure. She now relies on a tracheostomy for breathing support, having spent five months in the hospital.
Understanding the Risk

Dr. Jennifer Goldman, a pediatric infectious disease specialist at Children’s Mercy Kansas City, emphasizes the complexity of the situation: “These are good drugs, and this is a very rare condition, but it’s not commonly known and needs to be. There’s a window of opportunity to avert serious complications.” In rare cases, Bactrim has been linked to an inflammatory response in the lungs, potentially leading to acute respiratory distress syndrome (ARDS) and respiratory failure in young patients.
The Case That Started It All

While cases of severe Bactrim-related reactions had been reported before, the case of Zei Uwadia in 2018 gained national attention, prompting further investigation. Her story, which ended tragically shortly after her 17th birthday, sparked a crucial investigation into similar cases. Dr. Jenna Miller reflects, “It’s in Zei’s memory that we’re able to put these patients together and hopefully save future patients from having to go through this.”
Research Findings

In 2021, Dr. Goldman and Dr. Miller published a report documenting cases of acute respiratory distress syndrome (ARDS) following the antibiotic’s administration in 14 children and young adults. ARDS affects approximately 200,000 Americans annually, with causes ranging from infections to drug reactions, including rare cases linked to Bactrim. The outcomes were severe: three in ten patients died, and 20% required lung transplants.
Ongoing Investigation

Since the initial research, medical professionals have identified about two dozen more cases linked to the antibiotic. “That’s our goal. Bactrim’s a great drug, and we’d love to be able to use it for the 99% of patients who can tolerate it and have some kind of biomarker for the 1% who would be at high-risk for a reaction,” explains Dr. Goldman.
Regulatory Response

The FDA has added Bactrim to its watch list for potential safety concerns, indicating a need for further evaluation of reported adverse reactions. Dr. Miller notes the significance: “That was important because it added validation to our work. And we continue to work with the FDA on indications for using Bactrim because that would trickle down to providers.”
Education and Awareness

Healthcare professionals emphasize that this isn’t about condemning the antibiotic. “This is not a war on Bactrim, but it is highlighting potential adverse effects that have been overlooked or not observed in the past,” Dr. Goldman states. The goal is to raise awareness to the same level as other known drug reactions, such as Stevens-Johnson syndrome.
Looking Forward

Researchers continue their work to identify potential genetic markers that could help predict which patients might be at risk for severe reactions to the antibiotic. While data remains scarce and medical records can be challenging to obtain, the memory of patients like Zei Uwadia continues to drive research efforts forward.
Patients currently taking Bactrim should not discontinue use without consulting their healthcare provider.