{"id":29723,"date":"2026-02-01T04:48:00","date_gmt":"2026-01-31T20:48:00","guid":{"rendered":"https:\/\/csccm.org.cn\/?p=29723"},"modified":"2026-02-01T19:41:46","modified_gmt":"2026-02-01T11:41:46","slug":"jama-netw-open%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e9%9d%92%e5%b0%91%e5%b9%b4%e4%bd%bf%e7%94%a8%e5%a4%8d%e6%96%b9%e6%96%b0%e8%af%ba%e6%98%8e%e4%b8%8e%e6%80%a5%e6%80%a7%e5%91%bc%e5%90%b8","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=29723","title":{"rendered":"[JAMA Netw Open\u53d1\u8868\u8bba\u6587]\uff1a\u9752\u5c11\u5e74\u4f7f\u7528\u590d\u65b9\u65b0\u8bfa\u660e\u4e0e\u6025\u6027\u547c\u5438\u529f\u80fd\u8870\u7aed"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

Pharmacy and Clinical Pharmacology<\/p>\n\n\n\n

Trimethoprim-Sulfamethoxazole and Acute Respiratory Failure in Adolescents and Young Adults<\/h1>\n\n\n\n

Fatemeh\u00a0Ahmadi,\u00a0Eric\u00a0McArthur,\u00a0Facundo\u00a0Garcia-Bournissen,\u00a0et al<\/h3>\n\n\n\n

JAMA Netw Open 2025;8;(11):e2545251.\u00a0doi:10.1001\/jamanetworkopen.2025.45251<\/h3>\n\n\n\n

Key Points<\/p>\n\n\n\n

Question<\/strong>  Is the use of trimethoprim-sulfamethoxazole (TMP-SMX) associated with an increased 30-day risk of hospital visits for acute respiratory failure among healthy adolescents and young adults compared with amoxicillin or cephalosporins?<\/p>\n\n\n\n

Findings<\/strong>  In this cohort study of adolescents and young adults aged 10 to younger than 25 years in Ontario, Canada, initiation of TMP-SMX was associated with a significantly higher 30-day risk of a hospital visit for acute respiratory failure compared with amoxicillin and cephalosporins. The absolute risk increase was small (0.02%) but consistent across sensitivity analyses.<\/p>\n\n\n\n

Meaning<\/strong>  These findings support the US Food and Drug Administration\u2019s warning regarding the risk of acute respiratory failure with TMP-SMX in healthy adolescents and young adults, and clinicians and regulators should carefully weigh this risk when prescribing TMP-SMX and consider updates to prescribing guidelines and product labeling.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  The US Food and Drug Administration (FDA) has issued a warning and a label change regarding a potential association between trimethoprim-sulfamethoxazole (TMP-SMX) and acute respiratory failure in healthy adolescents and young adults.<\/p>\n\n\n\n

Objective<\/strong>  To examine the 30-day risk of a hospital visit (ie, hospitalization or emergency department visit) with acute respiratory failure in adolescents and young adults aged 10 to younger than 25 years old newly dispensed oral TMP-SMX compared with new users of amoxicillin or a cephalosporin.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  This retrospective, population-based, new-user cohort study in Ontario, Canada (2003-2023) used linked administrative health care data. The TMP-SMX vs amoxicillin and TMP-SMX vs cephalosporins cohorts both included adolescents and young adults aged 10 to younger than 25 years who were newly dispensed oral TMP-SMX, amoxicillin, or cephalosporins for 3 or more days from an outpatient pharmacy. Data were analyzed from January 1 to April 30, 2025.<\/p>\n\n\n\n

Exposure<\/strong>  TMP-SMX for 3 days or more.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  The primary outcome was a composite outcome of the 30-day risk of a hospital visit with acute respiratory failure (defined as a diagnosis of acute respiratory failure or receipt of mechanical ventilation, tracheotomy, or extracorporeal membrane oxygenation). Secondary outcomes were the individual components of the composite outcome, all-cause hospitalization, and all-cause mortality. Overlap weighting on the propensity score was used to balance comparison groups on 84 indicators of baseline health. Weighted risk ratios were obtained using log-binomial regression and weighted risk differences using binomial regression. Sensitivity analyses using a negative control outcome, and case-crossover analysis were also performed.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0The TMP-SMX vs amoxicillin cohort included 575\u202f218 individuals (44\u202f801 TMP-SMX users and 530\u202f417 amoxicillin users; median age after weighting, 19 years [IQR, 16-22 years]; 74.3% female). The TMP-SMX vs cephalosporins cohort included 248\u202f236 individuals (51\u202f197 TMP-SMX users and 197\u202f039 cephalosporin users; median age after weighting, 19 years [IQR, 16-22 years]; 72.3% were female). The risk of the composite outcome occurred in 15 of 44\u202f801 patients (0.03%) who started TMP-SMX and in 49 of 530\u202f417 (0.01%) who started amoxicillin (number of weighted events, 7 of 21\u202f579 [0.03%] for TMP-SMX and 2 of 21\u202f579 [0.01%] for amoxicillin; weighted risk ratio, 2.79 [95% CI, 1.01-7.71]; weighted risk difference, 0.02% [95% CI, 0.001%-0.04%]). The risk of the composite outcome occurred in 17 of 51\u202f197 patients (0.03%) who started TMP-SMX and in 21 of 197\u202f039 (0.01%) who started cephalosporins (number of weighted events, 8 of 20\u202f538 [0.04%] for TMP-SMX and 3 of 20\u202f538 [0.01%] for cephalosporins; weighted risk ratio, 2.85 [95% CI, 1.11-7.31]; weighted risk difference, 0.02% [95% CI, 0.005%-0.05%]). Results were consistent in sensitivity analyses.<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  These findings suggest that the 30-day risk of a hospital visit with acute respiratory failure was higher among those receiving TMP-SMX compared with those receiving amoxicillin or cephalosporins. These findings supported the FDA warning, and if replicated, the risks should be carefully weighed against the benefits of TMP-SMX use. Regulatory agencies could reinforce the FDA warning, and product monographs and prescribing guidelines should be updated and revised accordingly.<\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  Pharmacy and Clinical Phar […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/29723"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=29723"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/29723\/revisions"}],"predecessor-version":[{"id":29724,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/29723\/revisions\/29724"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=29723"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=29723"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=29723"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}