My husband is at Day +39 post autologous stem cell transplant (ASCT). Among his many medications prescribed for him during recovery is an antibiotic. He was taking dapsone (diaminodiphenyl sulfone) daily from the day of his discharge from the hospital, and just this week the myeloma specialist changed the antibiotic to Bactrim (sulfamethoxazole and trimethoprim), 3 times a week.
He had a check-up this past Friday with our local oncologist and the bloodwork showed an increased LDH (655), slightly increased AST, normal bilirubin, and increased eosinophils on differential (17%) after just 2 doses.
I am concerned over the increased LDH, AST and Eos; is this indicative of an allergic reaction to the Bactrim, or is this just normal "stuff" post ASCT since he is just a little over a month post transplant? Has anyone else had issues with taking Bactrim post ASCT? Did you stop taking the Bactrim and switch to another antibiotic?
My husband is doing well during recovery; each day has it's own challenge, but we are going in the right direction and I don't want anything to impede his progress to what our new "normal" life will be.
Any advice from others who have had an ASCT would be much appreciated! Thanks!
Forums
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ByYourSide - Name: Susan
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: December 2014
- Age at diagnosis: 65
Re: Antibiotics post stem cell transplant
Hello ByYourSide,
To the best of my recollection, my wife was not prescribed any antibiotics after discharge from the hospital (on day +16) in February. In the hospital, she did have them, big time. Thank God, she has not needed any up until now.
Two relatively small cases of the sniffles occurred, for which she used OTC meds. She does take a normal amount of other meds, which I can't recall off the top of my head, including an anti-viral, but no antibiotics. I understand that they would be prescribed quickly, as needed.
Regards,
To the best of my recollection, my wife was not prescribed any antibiotics after discharge from the hospital (on day +16) in February. In the hospital, she did have them, big time. Thank God, she has not needed any up until now.
Two relatively small cases of the sniffles occurred, for which she used OTC meds. She does take a normal amount of other meds, which I can't recall off the top of my head, including an anti-viral, but no antibiotics. I understand that they would be prescribed quickly, as needed.
Regards,
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JPC - Name: JPC
Re: Antibiotics post stem cell transplant
My husband is 141 days post ASCT. He was also prescribed Bactrim 3 times weekly. The only side effect he's complained of is digestive upset the day of the dose. No lingering effects come to mind. He's definitely looking forward to discontinuing it in another month or so though.
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reece93 - Name: reece93
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: October 2014
- Age at diagnosis: 57
Re: Antibiotics post stem cell transplant
My husband is 5 months post transplant. He also was prescribed Bactrim 3x week. He has not complained of any problems with it. He is also on acyclovir 2x day (was 3x day until this month). He just started 10 mg Revlimid maintenance so he is also on a baby aspirin every day. And he has to take a liver pill as a prophylactic (he had hepatitis 40 years ago) which will end around February. Other than that, he takes vitamins and other supplements with his doctor's knowledge - but no other prescribed medicine. His LDH, AST, etc. are all normal.
If you are concerned about any of your husband's results, can you reach out to his doctor (either his local onc or someone on his transplant team) for some assurance?
If you are concerned about any of your husband's results, can you reach out to his doctor (either his local onc or someone on his transplant team) for some assurance?
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Nanjeanne - Name: Nanjeanne
- Who do you know with myeloma?: My Husband
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 66
Re: Antibiotics post stem cell transplant
I was told that Bactrim can interfere with some lab tests, giving false readings. Check with the doctor to see if those are the ones you are concerned about.
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heddleandhook - Name: heddleandhook
- Who do you know with myeloma?: self
- When were you/they diagnosed?: Jan 2015
- Age at diagnosis: 68
Re: Antibiotics post stem cell transplant
Thanks, Heddleandhook, for the information about Bactrim, I didn't know that.
Apparently, Bactrim can cause measured creatinine levels to be higher than they really are. The prescribing information for Bactrim has this precaution:
Apparently, Bactrim can cause measured creatinine levels to be higher than they really are. The prescribing information for Bactrim has this precaution:
Drug/Laboratory Test Interactions: Bactrim, specifically the trimethoprim component, can interfere with a serum methotrexate assay as determined by the competitive binding protein technique (CBPA) when a bacterial dihydrofolate reductase is used as the binding protein. No interference occurs, however, if methotrexate is measured by a radioimmunoassay (RIA).
The presence of sulfamethoxazole and trimethoprim may also interfere with the Jaffé alkaline picrate reaction assay for creatinine, resulting in overestimations of about 10% in the range of normal values."
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JimNY
Re: Antibiotics post stem cell transplant
After my autologous stem cell transplant, I was prescribed Bactrim and when I went to the nursing home to see my Mother, I got C. diff. So, be very careful to avoid hospitals and nursing homes when taking antibiotics.
The Bactrim kills the healthy bacteria in your intestines and then you are more vulnerable to bad bacteria like C. diff.
Cathy
The Bactrim kills the healthy bacteria in your intestines and then you are more vulnerable to bad bacteria like C. diff.
Cathy
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antelope1225 - Name: Cathy1225
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: May 25 2012
- Age at diagnosis: 55
Re: Antibiotics post stem cell transplant
I am one month post transplant, and have been prescribed Bactrim, 3 times a week, for 6 months post transplant.
Is this a standard protocol? How can my gut ever recover if I continue antibiotics for another 5 months?
RT
Is this a standard protocol? How can my gut ever recover if I continue antibiotics for another 5 months?
RT
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RadiantTiger - Name: Radiant Tiger
- Who do you know with myeloma?: Myself, my deceased uncle
- When were you/they diagnosed?: Feb 2015
- Age at diagnosis: 54
Re: Antibiotics post stem cell transplant
I was prescribed Bactrim 30 days post transplant (1x daily for 30 days). I didn't have any side effects from the Bactrim.
I am now 86 days post transplant and I am taking an antibiotic (Augmentin) for a sore throat I picked up. Based on the responses given, different centers must have different protocols.
Rhonda
I am now 86 days post transplant and I am taking an antibiotic (Augmentin) for a sore throat I picked up. Based on the responses given, different centers must have different protocols.
Rhonda
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Rhonda - Who do you know with myeloma?: myself
- When were you/they diagnosed?: September 2014
- Age at diagnosis: 54
Re: Antibiotics post stem cell transplant
Here in Denmark they are very reluctant to give antibiotics to any patient without a specific indication. Of course, when it is related to myeloma, they are on guard and during periods of enhanced risk, they will check for infections once or more than once per day. But to my best knowledge they do not dispense antibiotics without an indication.
The general consent seems to be that it is important to be precise when ordering antibiotics to avoid resistance. And then they do of course have to react fast in cases where infection indicators rise fast and a patient's general condition deteriorates, and they may have to shoot before they aim, so to speak.
I had a lot of infections during my transplant. When the infection figures went up, they started with their best guess antibiotics and some broad spectrum types at once, while waiting for the analysis. And then they changed to using the telescope sight to hit precisely.
When they discharged me, I still had a few days left with one of the treatments, but they changed it to tablet form and let me continue with those at home. They came in every other day for tests.
The general consent seems to be that it is important to be precise when ordering antibiotics to avoid resistance. And then they do of course have to react fast in cases where infection indicators rise fast and a patient's general condition deteriorates, and they may have to shoot before they aim, so to speak.
I had a lot of infections during my transplant. When the infection figures went up, they started with their best guess antibiotics and some broad spectrum types at once, while waiting for the analysis. And then they changed to using the telescope sight to hit precisely.
When they discharged me, I still had a few days left with one of the treatments, but they changed it to tablet form and let me continue with those at home. They came in every other day for tests.
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Lev - Name: Lev
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: June 2014
- Age at diagnosis: 57
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