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Note: The resources listed in this guide are not intended to be fully systematic or complete, nor does inclusion here imply any endorsement or recommendation by The University of Maryland or the Center for Integrative Medicine. The University of Maryland and the Center for Integrative Medicine make no warranties, express or implied, about the value or utility for any purpose of the information and resources contained herein.

Antibiotic medications - sulfa drugs

Medications:

Co-Trimoxazole (Septrin)
Sulfamethoxazole (Gantanol)
Trimethoprim-Sulfamethoxazole (Bactrim, Bactrim DS)
Trimethoprim (Trimpex, Proloprim, Primsol)

Depletions:

Probiotics

Reducing the number of probiotic organisms, such as Lactobacillus acidophilus and Bifidobacterium bifidum, in the gastrointestinal tract may decrease the body's ability to resist infections and diseases. Symptoms of deficiency include gas, abdominal distress, diarrhea, and yeast infections.

Vitamin B2 (Riboflavin)

Symptoms of vitamin B2 deficiency may include cracks at the corners of the mouth, inflammation of the skin, growth retardation, and impaired wound healing.

Vitamin B9 (Folic Acid)

Low levels of folic acid have been linked to anemia, heart disease, birth defects, and colon cancer.

Vitamin B12 (Cobalamin)

Obvious symptoms of vitamin B12 deficiency are rare because it takes years to develop complications associated with long term depletion of this nutrient. Irritability, weakness, numbness, anemia, loss of appetite, headache, personality changes, and confusion are some of the signs and symptoms associated with vitamin B12 depletion. Low levels of this vitamin may also be associated with an increased risk of colon cancer, heart disease, brain disorders, and birth defects.

Vitamin H (Biotin)

Low levels of biotin are associated with changes in skin color, inflammation of the skin, hair loss, muscle pain, anemia, loss of appetite, depression, insomnia, and elevated levels of cholesterol.

Vitamin K

The major symptom of vitamin K deficiency is an inability of the blood to clot properly, which may lead to excessive bleeding and a tendency to bruise easily.

Editorial Note:

The selected depletions information presented here identifies some of the nutrients that may be depleted by certain medications. The signs and symptoms associated with nutrient deficiency may also indicate conditions other than nutrient deficiency. If you are experiencing any of the signs or symptoms mentioned, it does not necessarily mean that you are nutrient deficient. Nutrient depletion depends upon a number of factors, including your medical history, diet, and lifestyle, as well as the length of time you have been taking the medication. Please consult your health care provider; he or she can best assess and address your individual health care needs, and determine if you are at risk for nutrient depletions from these medications, as well as others not listed here.

Reviewed last on: 4/19/2010
Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed HealthCare Network.

Supporting Research

Ames BN. Micronutrient deficiencies: A major cause of DNA damage. Ann NY Acad Sci. 2000;889:87-106.

Beaugerie L. [Diarrhea caused by antibiotic therapy]. Rev Prat. 1996;46(2):171-176.

Conly J, Stein K. Reduction of vitamin K2 concentrations in human liver associated with the use of broad spectrum antimicrobials. Clin Invest Med. 1994;17(6):531-539.

de Vrese M, Marteau PR. Probiotics and prebiotics: effects on diarrhea. J Nutr. 2007;137(3 Suppl 2):803S-11S.

Fitzgerald MA. Drug-induced vitamin B12 deficiency. Nurse Pract. 2007;32(9):6-7.

Goldman: Cecil Medicine, 23rd ed. Philadelphia, PA: Saunders Elsevier Inc. 2007.

Hickson M, D'Souza AL, Muthu N, Rogers TR, Want S, Rajkumar C, Bulpitt CJ. Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics: randomised double blind placebo controlled trial. BMJ. 2007;335(7610):80.

Hill MJ. Intestinal flora and endogenous vitamin synthesis. Eur J Cancer Prev. 1997;6(Suppl 1):S43-45.

Hvas AM, Nexo E. Diagnosis and treatment of vitamin B12 deficiency -- an update. Haematologica. 2006;91(11):1506-12.

Isakow W, Morrow LE, Kollef MH. Probiotics for preventing and treating nosocomial infections: review of current evidence and recommendations. Chest. 2007;132(1):286-94.

McFarland LV. Diarrhoea associated with antibiotic use. BMJ. 2007;335(7610):54-5.

Moretti R, Torre P, Antonello RM, Cazzato G, Cattaruzza T, Scapicchio PL. Vitamin B12 and folate depletion: clinical evidence in a neurological population. Neurologist. 2004;10(6):338-43.

Naderer O, Nafziger AN, Bertino JS. Effects of moderate-dose versus high-dose trimethoprim on serum creatinine and creatinine clearance and adverse reactions. Antimicrob Agents Chemother. 1997;41(11):2466-2470.

Pelton R, LaValle J, Hawkins EB, et al. Drug Induced Nutrient Depletion Handbook. Hudson, OH:LexiComp, Inc.;2001:374-385.

Powers HJ. Current knowledge concerning optimum nutritional status of riboflavin, niacin and pyridoxine. Proc Nutr Soc. 1999;58(2):435-440.

Powers HJ. Riboflavin (vitamin B-2) and health. Am J Clin Nutr. 2003;77(6):1352-60.

Reynolds E. Vitamin B12, folic acid, and the nervous system. Lancet Neurol. 2006;5(11):949-60.

Saavedra JM. Use of probiotics in pediatrics: rationale, mechanisms of action, and practical aspects. Nutr Clin Pract. 2007;22(3):351-65.

Svenson J. Neurologic disease and vitamin B12 deficiency. Am J Emerg Med. 2007;25(8):987.e3-4.

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