Bactrim Lung Failure Team

About the Team

Jenna Miller, MD, FAAP and Jennifer Goldman, MD, MSCR first described severe respiratory failure after Bactrim (Trimethoprim-Sulfamethoxazole) exposure in 2019. In 2018, one of Dr. Miller's long term extracorporeal membrane oxygenation (ECMO) patients was featured in a CNN Health article as she walked and talked about her experience while using the lung bypass machine. Her story caught the attention of other patients and families who felt like her tale was like their own. They, too, shared stories that often lead to severe lung failure requiring ECMO or lung transplant, with some cases ending in death.

After discussing with friend and co-collaborator, Dr. Goldman, Dr. Miller and the team reviewed the cases of those who reached out. They published five pediatric cases in Pediatrics in 2019. The more they were able to share concerns about Bactrim as a trigger for severe acute respiratory distress syndrome (ARDS), the more requests for patient evaluations were received. In 2021, they published cases of young adults and described associated pathology in the American Journal of Respiratory and Critical Care Medicine. The pathology first reported by their colleagues, Martin Taylor, MD, PhD, Angela Shih, MD, and Mari Mino-Kenudson, MD, Massachusetts General Hospital, is called Diffuse Alveolar Injury with Delayed Epithelialization. With the addition of a genomic human leukocyte antigen (HLA) marker discovered in collaboration with the Genomic Medicine Center and Tomi Pastinen, MD, PhD, they developed a three-part definition that includes clinical, pathology and genomics explanations for the disease process. This clinical definition was published in Critical Care Medicine in 2023. In the summer of 2021, the Food and Drug Administration (FDA) changed the label for this drug to include this rare reaction and the team is in regular communication with the FDA regarding ongoing discovery.