December 2, 2022

Dear doctor: Can I take sulfonamide antibiotics for long periods of time?

DEAR DR. ROACH: As a healthy 90 year old male, I have been taking one Bactrim (sulfamethoxazole/trimethoprim) pill daily for several years now as a preventative for recurrent urinary tract infections. I am very satisfied with this successful treatment. However, my urologist mentioned that I might have to go off Bactrim at some point without a full explanation of why. Is there a danger in the habitual use of Bactrim? –JM

ANSWER: Men and women who get recurrent UTIs are sometimes treated with prophylactic antibiotics, like the sulfa antibiotic you are taking. The main risk is not drug toxicity; is that you could acquire a bacterial strain that is resistant to antibiotic treatment. You are lucky to have gone several years without it developing, and you can achieve much more, but other people have to periodically change the antibiotic they are taking.

Prophylactic antibiotics are not the first-line treatment to prevent recurrent infections. Urologists, specialists in the urinary tract, will evaluate the urinary system to try to identify a correctable condition. I hope your urologist has considered other options before prescribing your current treatments.

DEAR DR. ROACH: I have a question about smoking. I smoke cigarettes, but now I want to quit. I want to use Velo to break this habit. Are Velo sachets harmful to health? Are there any side effects? –Z

ANSWER: Velo is a nicotine brand (there are a lot of them now) designed simply to deliver nicotine without smoking. Nicotine is derived from tobacco, but there is no real tobacco in the product. The health risk is much lower compared to smoking tobacco and much less than chewing tobacco. They come in the form of lozenges and sachets (which are placed under the lip); many are flavored. Nicotine does not cause cancer, but there is still potential to harm health, especially in the mouth, especially for gum disease.

Unlike nicotine replacement products, such as patches, gummies, and inhalers, which are intended to help people quit smoking and then taper off, these nicotine products are intended for long-term use. . These should never be used by anyone who does not smoke or use other forms of nicotine, as nicotine can make a person very sick if they are not used to it. It can cause nausea and vomiting, but also abdominal pain, headaches and mouth irritation.

I strongly recommend that you quit smoking with the help of behavioral support, through group sessions or counseling, and consider drug therapy, such as varenicline (Chantix) or bupropion (Wellbutrin or Zyban) in addition to nicotine replacement therapy. There is not enough information to say how effective a nicotine product like Velo would be in helping you quit smoking. For people who have successfully quit smoking but continue to crave nicotine, long-term nicotine is not ideal, but it still poses far fewer health risks than smoking.

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Dr Roach regrets that he cannot respond to individual letters, but will incorporate them into the column whenever possible. Readers can send questions to [email protected] or mail to 628 Virginia Dr., Orlando, FL 32803.

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