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Is septrin banned in Nigeria as claimed in viral audio?

Claim 1: In a viral audio clip circulating on WhatsApp, a man warned Nigerians against using Septrin, claiming it could cause significant skin peeling.

Is septrin banned in Nigeria as claimed in viral audio?

Verdict: True! One of the side effects of Septrin, widely sold over-the-counter, is flaking of the skin, also known as Stevens-Johnson Syndrome. However, this side effect is very rare. 

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Recently, an audio clip that went viral on WhatsApp was shared with DUBAWA. In the clip, a man who spoke in Yoruba enjoined listeners to avoid Septrin tablets, warning that their usage could lead to severe consequences.

The man, whose identity remains unknown, claimed that a female colleague at work had taken two tablets of Septrin to treat a persistent cough that hadn’t improved after two days of home remedies. He added that a few hours after taking the medication, her skin became itchy and began peeling.

He said the colleague rushed to the hospital to report the issue, and when she saw the doctor, she was asked if she had taken Septrin.

He said: “Few hours after using the medication, she observed her skin was itchy. And as she’s scratching, her skin peels off. In fact, her skin peeled off on the bed sheet. She couldn’t even put on her clothes. She had to tie a wrapper and go to the hospital. The doctor asked if she used Septrin and she confirmed it.” 

Considering the potential impact of the viral claim on the usage of the drug, DUBAWA decided to fact-check it.

What is Septrin?

Septrin is a brand name for Co-trimoxazole, an antibiotic used for the prevention and treatment of some bacterial infections. Co-trimoxazole contains two separate antibiotics called trimethoprim and sulfamethoxazole.

Aidsmap explained that Septrin is usually used to prevent Pneumocystis jiroveci pneumonia), particularly in people living with HIV. It also noted that the drug helps to reduce the risk of toxoplasmosis, an infection that can affect the brain.

Medlineplus emphasised that Septrin will not kill the viruses that can cause colds, flu, or other viral infections. However, it advised that the drug be taken as directed by a medical expert and urged users to report any allergies that they might have. 

Does Septrin cause flaking of the skin?

One of the major side effects of the drug, as listed by Mayo Clinic is blistering, peeling, or loosening of the skin. 

Corroborating this, Cleveland Clinic noted that the drug could cause “redness, blistering, peeling, or loosening of the skin, including inside the mouth”.

Meanwhile, a 2020 study noted that the risk of developing Stevens-Johnson Syndrome from cotrimoxazole use is rare, with an incidence rate of one case per million people per year.

According to the study, a 50-year-old patient was reported with SJS after using cotrimoxazole for two weeks due to a history of unresolved pneumonia and wound excision procedure, which was likely a factor.

Also, the patient was said to have been under some drugs for diabetes and hypertension. 

The study noted that while there have been some incidences of SJS from cotrimoxazole, it doesn’t come under the most popular drugs accredited to cause the disease.

Another study confirmed there is a possibility of Stevens-Johnson Syndrome resulting from the usage of cotrimoxazole. With a focus on persons living with HIV and AIDS, the study noted that these individuals have up to a 1000-fold increased risk of drug hypersensitivity reaction, “associated with drug exposure, immune dysregulation, and concurrent infections”.

Is septrin banned in Nigeria as claimed in viral audio?
Image of patient affected by the Stevens-Johnson Syndrome Source: Cleveland Clinic

In addition to the studies on the medical condition, DUBAWA spoke with Doctor Francis Agbaraolorunpo, a medical practitioner at the University of Lagos (UNILAG), to get further insights. Mr  Agbaraolorunpo explained that while the peeling of the skin is a known side effect of Septrin, it is rare. 

He said: “That is Stevens Johnson Syndrome though it is very rare. The sulfonamide that causes it is in the class of Fansidar. Has the person used Fansidar before? Did they react to the chemical compound? That’s why we ask patients which drug they are allergic to. Have they used the drug before and was there any reaction or was it just this particular one because you cannot just create that fear. Stevens-Johnson Syndrome occurs but it’s very rare.”

He explained that several factors are considered before a decision will be made regarding whether to issue a disclaimer warning people against using Septrin or not. 

Mr Agbaraolorunpo said factors such as the patient’s medical history, other drugs used alongside the Septrin, changing of body cream, source of the product, and other things will be considered to ascertain what might have triggered the reaction. 

“When we talk about reaction, the body probably saw the drug as a stranger and the body needed to defend itself. It could be because of some changes, maybe the person used it with another drug or what is the source of the Septrin. Is the person on a new cream that is already making the skin to be viewed as stranger by the body’s defence mechanism? There is a need for investigation into the exact cause. 

“When there is a drug reaction, there are pharmacovigilance groups. The case has to be reported, the drug batch should be studied, get samples of the persons affected and if there is a widespread report, they work in conjunction with NAFDAC.”

He said the Stevens-Johnson Syndrome, being a side effect of the drug, is like one in over 2,000 cases. 

He, however, warned against the indiscreet use of social media, noting that though the platforms are readily available for use by all, it should not be misused to spread false information or put fear in people. 

The medical doctor also warned against self-medication, urging those who might be using the drug under prescription to raise whatever concerns they have with their doctors, rather than totally avoiding the medication.

“If we tell you the side effects of drugs, you may not want to take any at all. This Stevens-Johnson Syndrome is rare, we weigh the pros and the cons. That’s why self-medication is not good and the source of the drug, where did you get your medications and under which conditions did you use the medication because there are drug reactions. It’s individual-based.”

In the same vein, Dr Qudus Lawal, Director of Programs at End Cervical Cancer Nigeria Initiative, told DUBAWA that  peeling of skin can happen, but not in everybody.

“It can affect some people. It is a known side effect of the drug. The whole skin can peel, it is the Stevens-Johnson Syndrome TEN.”

Claim 2: Doctors and NMA wrote federal government to ban use of Septrin

Is septrin banned in Nigeria as claimed in viral audio?

Verdict: False! NMA told DUBAWA that the association did not take such a step regarding the drug as claimed.

In the viral clip, the man further claimed that doctors as well as the Nigerian Medical Association (NMA) had written to the federal government to ban use of the drug.

“The doctor said they’d asked people not to use the drug anymore and the Nigeria Medical Association wrote the Federal government to ban the drug but the federal government had yet to take action. They also brought someone from Òmù-àrán, a city in Kwara state who suffered same fate,” he added.

But did doctors and NMA write FG to ban Septrin?

To ascertain this, DUBAWA  contacted Dr Bala Audu, the president of the Nigeria Medical Association. He  debunked the claim that the association wrote the federal government about Septrin.

He said, “That’s not true. The NMA did not send any letter to the federal government to ban Septrin. I don’t know where you got that information.”

Conclusion 

Though peeling of the skin is a known side-effect of Septrin, several studies, corroborated by medical experts who spoke with DUBAWA, showed that it is very rare. Neither doctors nor the NMA also wrote the federal government to ban the drug.  

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