Aplastic Anemia Associated With Prolonged High‐Dose Trimethoprim‐Sulfadiazine Administration in Two Dogs

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Abstract
Trimethoprim‐sulfadiazine (TMP‐SDZ) (Tribressin tablets 120‐100 mg sulfadiazine, 20‐mg trimethoprim [Coopers Animal Health, Inc., A Pitman‐Moore Company, Mundelein, III.]) is a broad spectrum antibiotic combination effective in the treatment of bacterial pneumonia, urinary tract infections, pyoderma, meningitis, and prostatitis.1In clinical trials in puppies and adult dogs, TMP‐SDZ was considered safe at both the manufacturer's recommended dose (15 mg/kg, b.i.d., or 30 mg/kg, u.i.d., per os for < 14 days2) and at 10 times that dose for 20 days.3Many infections, however, require prolonged high‐dose therapy for resolution. The following study describes two cases of aplastic anemia and sepsis associated with intermittent, chronic (17–25 days), high‐dose (25–30 mg/kg, b.i.d., per os) TMP‐SDZ therapy recommended for the treatment of pyoderma.4–7