TMP-SMX Linked to Higher Short-Term Risk of Acute Respiratory Failure in Youth

Background: Trimethoprim-sulfamethoxazole (TMP-SMX) is widely prescribed to adolescents and young adults for common infections. In 2021, the U.S. Food and Drug Administration (FDA) issued a warning regarding a possible association between TMP-SMX and acute respiratory failure in otherwise healthy younger populations. Robust population-based evidence to contextualize this risk is limited. Objective: To evaluate the 30-day risk of hospital visits for acute respiratory failure among adolescents and young adults newly dispensed oral TMP-SMX compared with new users of amoxicillin or cephalosporins. Design: Retrospective, population-based, new-user cohort study using linked administrative health care databases from Ontario, Canada, spanning 2003 to 2023. Methods: Adolescents and young adults aged 10 to Results: The TMP-SMX versus amoxicillin cohort included 575,218 individuals, and the TMP-SMX versus cephalosporin cohort included 248,236 individuals. The median age after weighting was 19 y more...