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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

We read with great interest the review of Masters et al¹ about trimethoprim-sulfamethoxazole (TMP-SMZ).¹ It is a very high-quality article with critical review of the published data. However, we disagree with the commentaries of Masters et al concerning the hematological toxicity of TMP-SMZ, particularly concerning agranulocytosis.¹ Thus, although TMP-SMZ–induced agranulocytosis is a "rare" adverse effect (the exact incidence is not known), it remains our opinion a serious potential life-threatening adverse effect,² as we report herein.

During 15 years (1985-2000), 9 cases of TMP-SMZ–induced agranulocytosis have been registered in a prospective cohort study (n = 91).² The mean dose of TMP-SMZ was 1400 mg/d (range, 800-2400 mg/d) and the mean duration of the drug intake was 37 days (range, 3-17 days).

The median age of the patients was 69 years, (range, 22-92 years) and the male-female ratio was 2. Main clinical characteristics included septicemia or septic shock (n = 6) and . . . [Full Text of this Article]

Emmanuel Andrès, MD; Esther Noel, MD; Frédéric Maloisel, MD
Strasbourg, France

RELATED ARTICLE

Trimethoprim-Sulfamethoxazole–Induced Life-Threatening Agranulocytosis—Reply
Philip A. Masters, Thomas A. O'Bryan, John Zurlo, Debra Q. Miller, and Nirmal Joshi
Arch Intern Med. 2003;163(16):1976.
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