Is Bactrim a “heavy duty” or “light duty” antibiotic? Skinny inside.

January 1, 2007 7:30 PM

I had a boil on my neck and went to see a Nurse Practitioner who prescribed a two week two a day supply of Bactrim, which was filled as the generic version (MP85 stamped on pill -specific info on the bottle wore off). Fast forward two weeks, the original boil went down but I got another one in the meantime so I know its not working. I know that current thinking these days is to not prescribe uber-strong antibiotics as to not build up resistance to super-bugs… Did I get a starter antibiotic? Yes, Im planning on going back, I just am curious how ‘strong’ Bactrim is.. I know its not Cipro. Where is Bactrim on the pecking order of antibiotics?
posted by freeflytim to health & fitness (13 comments total)

Bactrim is pretty "heavy duty" and is used to treat skin staph infections, among other things.

Is your other boil painful? Does it appear the same as the first one? Is it getting worse?

I would get to the doctor ASAP. Not to be an alarmist, but you may have MRSA (Methicillin Resistant Staphylococcus Aureus), which is found in the community more and more. Bactrim is an effective med to treat MRSA most of the time, but sometimes staph can be more serious and require IV antibiotics.

I hope a doctor chimes in and gives better info.

Good luck and health to you.
posted by LoriFLA at 7:43 PM on January 1, 2007

From what I could gather Bactrim is just a growth inhibitor of bacteria, as opposed to something like Cipro which actually goes for the throat and kills the bacterium outright.

So really they're in different categories, not even on a continuum per say.

See here here and here for more info.
posted by jourman2 at 7:45 PM on January 1, 2007

Forgot to ask if they cultured your first boil.
posted by LoriFLA at 7:45 PM on January 1, 2007

Real simple-like, but not even approaching comprehensive: antibiotics are prescribed to cover specific organisms. These organisms are lumped into categories such as gram-positive, gram-negative, and anaerobic bacteria.

Bactrim covers gram-negatives and gram-positives. It's commonly used against gram-negatives such as E. Coli, as well as gram-positives including some Strep and Staph. This leads to its use for UTIs as well as skin abscesses.

With the rise in methicillin-resistant Staph Aureus (MRSA), people are finding that some antibiotics previously prescribed for skin infections, such as Keflex and penicillins, aren't doing the job. This has led to an increase in use of Bactrim for such infections. Other regiments such as clindamycin + rifampin are used as well.

In short: you probably got an appropriate "starter" antibiotic. I have no idea what the abscess looked like, or where you live, what your medical history is, etc. Some practitioners still prescribe Keflex first. You could've just as easily received a prescription for Keflex, or clindamycin, or an addition of rifampin to either Bactrim or clinda. It really depends on where you live, what the suspicion for MRSA is, and how bad the abscess was.

It's important to note that the primary treatment for most abscesses is incision and drainage. Depending on the severity, this alone is indicated and effective-- no antibiotics are required or recommended. When this is done, a wound culture should be sent off to see what's growing, and what it's sensitive to in terms of antibiotics.


There are important differences between MRSA typically found in the hospital and community-acquired MRSA. So don't panic, see your physician, and ask questions.
posted by herrdoktor at 7:54 PM on January 1, 2007 [1 favorite]

Having worked in a veteran's center, where MRSA is rampant, I would tend to agree with LoriFLA.
posted by drleary at 7:54 PM on January 1, 2007

Note: by "don't panic," I mean don't go taking a bleach bath or thinking that your face is going to be eaten off. Even being positive for community-acquired MRSA necessitates contact isolation precautions in the hospital, and a big note in your record saying you've a history of being MRSA-positive, as well as consideration of eradication measures. My nonchalance comes from dealing with it nearly every day.

Who knows, though? It might not even be MRSA!
posted by herrdoktor at 8:01 PM on January 1, 2007

There are important differences between MRSA typically found in the hospital and community-acquired MRSA. So don't panic, see your physician, and ask questions

I am glad herrdoktor said this. I didn't want to imply, get to the doctor stat, you have MRSA, you are going to croak.
posted by LoriFLA at 8:01 PM on January 1, 2007

Who knows, though? It might not even be MRSA!

Exactly.
posted by LoriFLA at 8:03 PM on January 1, 2007

Thanks all.
Im not panicking!
The NP was at a "Doc in the box" at a local grocery store and I do feel that I had good care in the 30(!) minutes we spent together (I was the only client and pretty much got a full check-up with my pants on!). She said she would have liked to lanced it, but she wasn't set up it. My health is that I can't remember the last time I was sick..
Yes.. Im going back!
posted by freeflytim at 8:31 PM on January 1, 2007

Bactrim is a sulfa antibiotic, really the last of the sulfa antibiotics to be in wide use. One of the side benefits of this is that there's not much cross resistance between it and other antibiotics.

Antibiotic therapy is always empiric to some degree: does it work for the bug it was prescribed to kill, and did it make the patient get an opportunistic infection? In order to find out, you have to give it a try.
posted by ikkyu2 at 8:36 PM on January 1, 2007

bactrim is a broad-spectrum antibiotic, working on Gram + and Gram - bacteria. it's definitely a first line starter.
posted by brandz at 8:40 PM on January 1, 2007

I have horrible skin, for which I've been seeing a dermatologist. He tried absolutely everything possible for three years, and only then, last summer, did he reluctantly start me on Bactrim. By then, had tried everything he was willing to prescribe me (including Retin-A; he refused to give me Accutane) with no effect. He's still not happy about letting me have Bactrim, and I keep having to get my blood tested to make sure my liver and kidneys are functioning (so far, so good).

I'm not telling you this to scare you about your liver and kidneys -- I'm sure the danger increases with higher doses and longer use. But at least one doctor thinks that using Bactrim for skin eruptions is Serious Business.
posted by booksandlibretti at 8:59 PM on January 1, 2007

Agreed. Bactrim is pretty heavy duty. I had MRSA that I brought back from Malaysia, and got some. Fun times!
posted by zpousman at 7:12 AM on January 2, 2007