Prophylactic Antibiotics

Just got home with a prescription for antibiotics, which are intended to protect me from infection once alemtuzumab does its thing to my immune system.

They are CO-TRIMOXAZOLE which is a combo of two antibiotics, Trimethoprim and Sulfamethoxazole (info here).

I think the neurologist explained that they were used variably by different hospitals (some do, some don’t) as a prophylactic – which he told me in the context of listeria prevention. Interestingly, the alemtuzumab administration guidelines  refer to using trimethoprim/sulfamethoxazole as antibiotic prophylaxis for Pneumocystis jiroveci pneumonia (PCP) rather than listeria – the only reference to Listeria is to give advice about ensuring riskier foods are adequately heated.

Patients should receive anti-infective prophylaxis to minimize the risk of opportunistic infections.
In chronic lymphocytic leukemia patients, trimethoprim/sulfamethoxazole DS twice daily 3 times per week or the equivalent for Pneumocystis jiroveci pneumonia (PCP) prophylaxis and famciclovir 250 mg twice daily or the equivalent for herpetic prophylaxis are recommended.
In multiple sclerosis patients, anti-viral prophylaxis for herpetic viral infections should be given on the first day of each treatment course.
Continue prophylaxis for >= 2 months following treatment or until the CD4+ count is >= 200 cells/microliter, whichever occurs later…

Prophylaxis against Pneumocystis jiroveci pneumonia (PCP) and herpes infection has been shown to decrease, but not eliminate, the occurrence of these infections. Prophylactic antibiotics are recommended upon the initiation of therapy and for a minimum of 2 months after the last dose of alemtuzumab or until the CD4+ counts are >= 200 cells/mcl, whichever occurs later…

[Additionally, advise all patients to adequately heat foods that are potential sources of Listeria monocytogenes. ]

[I didn’t know what PCP was, although it is listed as a specific use for Co-Trimoxoazole. Google provides these details.]

So there you have it. Just need to check now when I need to start taking the antibiotics – the two different MS nurses have given two different sets of advice, and comments from fellow patients suggest they have been told something else entirely! Waiting for a call back…

Meanwhile, Sainsbury’s have just recalled a bunch of refrigerated sandwich fillers due to listeria risk, so those dietary precautions are looking less and less like overkill!


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