Trimethoprim Allergy Recording — SCE Rheumatology MCQ

Correct answer: B — Code trimethoprim and co-trimoxazole as allergy or contraindication warnings in the electronic record

The correct answer is B. UK methotrexate shared-care guidance recommends entering trimethoprim and co-trimoxazole as coded allergy or contraindication warnings in the patient record so that electronic prescribing systems generate an alert. This is a safety label rather than a claim of immunological hypersensitivity. Trimethoprim and co-trimoxazole have additive antifolate effects with methotrexate and can cause severe marrow suppression, including acute megaloblastic pancytopenia. A repeat-medication entry alone may not generate an adequate alert. Patient counselling remains important but cannot replace record-based safeguards, particularly during out-of-hours care. Hospital-only documentation may be unavailable to community prescribers, while an undocumented verbal warning relies entirely on patient recall.

Reference: NHS Dorset Integrated Medicines Optimisation Committee. Shared Care Protocol: Methotrexate (oral and subcutaneous) for patients in adult services, sections 4 and 7. Updated June 2025. https://nhsdorset.nhs.uk/Downloads/aboutus/medicines-management/Shared%20Care%20Guidelines/Methotrexate%20Shared%20Care%20Protocol%20Jun%2025.pdf?boxtype=pdf&g=false&r=wide&s=true&s2=false