Let’s talk about Sulfonamides — the antibiotics that walked so TMP-SMX could run… right into a minefield of adverse effects. 😬
If you’ve ever prescribed co-trimoxazole with blind optimism, only to have the patient return looking like they auditioned for a dermatology poster on Stevens-Johnson Syndrome, you’ll know what I mean.
A few months ago at our hospital, a young lad from Washuk, Balochistan, was started on TMP-SMX for Pneumocystis jirovecii pneumonia. Fast-forward 3 days — he came back with a fever, rash, oral ulcers, and panic in his father’s eyes. Dr. Bilal Chaudhary was the first to suspect SJS — and boy, was he right. ⚡
Moral of the story? Know your drugs. Know your mnemonics.
🧠 Mnemonic: “SULFONAMIDE”
| Letter | Side Effect | Clinical Insight |
|---|---|---|
| S | Steven-Johnson Syndrome / Skin rash | When sulfa meets keratinocytes — chaos. Respect the rash. 🚨 |
| U | Urine (crystalluria, nephrotoxicity) | Seen AKI in a guy with no risk factors? Blame the sulfa. Hydration is key. 💧 |
| L | Lupus-like syndrome | Rare, but when it shows up, rheumatology gets excited. 🦋 |
| F | Fever | A classic delayed hypersensitivity sign. Don’t confuse it with “infection failure.” 🌡️ |
| O | Oxidative stress in G6PD deficiency | Hemolysis galore. If your patient’s from Dera Bugti, check that G6PD status. 🩸 |
| N | Nausea / GI upset | Dr. Basit Khan’s golden rule: Warn early or face the consequences in OPD. 🤢 |
| A | Allergy (Type I to IV hypersensitivity) | Rashes, hives, or anaphylaxis — it’s a whole buffet. Pick your poison. 🧪 |
| M | Megaloblastic anemia | Folate antagonism = tired patient + confusing CBC = many calls to hematology. 📉 |
| I | Interstitial nephritis | Not just glomeruli — even the tubules hate sulfonamides sometimes. 🧠➡️🧽 |
| D | Drug-induced photosensitivity | “Doctor, I went to Gwadar for a wedding and now my skin hates the sun!” ☀️😎 |
| E | Embryotoxic (Teratogenic) | Avoid in pregnancy — especially in the first trimester. Dr. Danish Ramzan insists. 👶 |
🏥 Ward Encounters from Quetta
I remember once, on a call with Dr. Behroz Rahim, a patient from Nok Kundi came in with new-onset confusion. Psych team was looped in, but the underlying cause? Sulfa-induced hyponatremia + fever + delirium = diagnostic chaos. Turned out to be Type IV hypersensitivity reaction to TMP-SMX.
Sometimes, side effects are like quiet roommates — you forget they’re there until they burn the kitchen down.
Happy learning, folks! 🙂
👨⚕️ Written by:
Dr. Aurangzaib Qambrani
MBBS, PLAB, MRCP-UK
Sheikh Khalifa Bin Zayed Hospital, Quetta
