View Full Version : A Sincere Apology to.....SMZ/TMP

island rehabber
11-05-2020, 09:55 PM
SMZ/TMP...sulfamethoxazole and trimethoprim....Bactrim...old-school antibiotic that has gotten the reputation for being slow-acting and not all that effective. Since here at TSB we are most often dealing with aspiration pneumonia in babies, I have been the first person on line to disparage the use of SMZ/TMP and push Baytril or Cipro because of their swift action.

I'm so sorry, SMZ. My recent experience treating squirrels with fibroma (squirrel pox) has raised you to a new level of respect in my book. I have two with remaining lesions on their eyes and nothing -- not even the almighty Baytril -- had touched these lesions for over five weeks. I had SMZ in the cabinet...oh what the hell, let's try it.

Typically of SMZ, nothing happened immediately either. And then on the 6th day I woke up to find my squirrels' eye lesions noticeably smaller, dryer and shrunken. Today, the 11th day, the differences are remarkable and I am soooo happy.

So, yeah, SMZ, you're slow. But you turned the corner for my kids so I sincerely apologize for trashing you. Thanks! :grouphug

11-05-2020, 10:19 PM
Good news always welcome.

11-06-2020, 06:43 AM
I totally agree. The sulfa drugs are definitely old school but they have the advantage of not developing the resistance over the years that the other antibiotics have. Some of the most resistance organisms are now being treated successfully with Septra. An antibiotic that had mostly been replaced with newer generations of antibiotics has now gained new respect because it STILL works for resistant organisms whereas others don’t. The drug of choice for uncomplicated MRSA wound infections is SMZ/TMP (Septra). It has broad coverage including both Gram positive and Gram negative organisms. It has no coverage for anaerobes so a wound suspected of having anaerobes (deep wound with foul odor or near a mucous membrane) shouldn’t be treated with SMZ/TMP alone. It should be stacked with an antibiotic that covers for anaerobes.

I have very little confidence in Ciprofloxacin or Baytril. When they were first introduced they were awesome but due to the development of resistance their use is limited to situations where Gram negative organisms are involved. The GI flora is predominantly Gram negative organisms so any infection that might be due to fecal contamination or proximity to the GI tract (aka UTI) is appropriate to use a fluoroquinolone like Ciprofloxacin or Baytril. It should never be used for treating wounds alone.

To be honest with you, I have no idea why Ciprofloxacin is so effective for aspiration pneumonia. I like the fact that you will see a turn around in 18-24 hrs. In my mind, based on coverage it shouldn’t even work but it does.

island rehabber
11-06-2020, 07:51 AM
:bowdown :thankyou:thankyou Patti I was so hoping you would weigh in on this, thanks! (Almost PM'd you about it, but didn't want to bother you :grouphug.)

In my mind, based on coverage it shouldn’t even work but it does.

That's like the Zovirax -- even my vet said it should not work for pox -- pox is "not a herpes virus". Except that it does. :grin3