Document Detail


Use of low-dose trimethoprim-sulfamethoxazole thrice weekly for primary and secondary prophylaxis of Pneumocystis carinii pneumonia in human immunodeficiency virus-infected patients.
MedLine Citation:
PMID:  1952835     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We conducted an open prospective clinical trial to evaluate the efficacy and toxicity of trimethoprim-sulfamethoxazole given as one double-strength tablet thrice weekly for primary and secondary prophylaxis of Pneumocystis carinii pneumonia (PCP) in human immunodeficiency virus-infected (HIV+) patients. A total of 104 HIV+ patients were evaluated, with 74 being in the primary prophylaxis group and 30 being in the secondary prophylaxis group. All except six patients received concomitant zidovudine; five patients on primary prophylaxis and one patient on secondary prophylaxis refused zidovudine. There were 70 patients evaluated for the efficacy of primary prophylaxis. The mean CD4 count was 124.4 +/- 110.1 cells per microliter. The mean follow-up time was 11.8 +/- 5.8 months (median, 12 months; range, 1 to 32 months). Two noncompliant patients developed PCP after 1 and 3 months of chemoprophylaxis. The failure rate (under the intention to treat principle) was 2 of 70 patients (2.9%; 95% confidence interval, 0.35 to 10%), or 1 per 413 patient-months of observation. There were 27 patients evaluated for the efficacy of secondary prophylaxis. The mean follow-up time was 12.4 +/- 7.2 months (median, 11 months; range, 1 to 29 months). Two patients, one of whom was noncompliant, were treatment failures, developing PCP after 14 and 15 months of chemoprophylaxis; this gave a failure rate of 2 of 27 patients (7.4%; 95% confidence interval, 0.9 to 24.3%), or 1 per 167 patient-months of observation. Adverse reactions sufficient to permanently terminate therapy occurred in 9 of 104 patients (8.7%; 95% confidence interval, 4 to 15.7%) overall. The serum trimethoprim, sulfamethoxazole, and N4-acetyl-sulfamethoxazole concentrations measured by high-pressure liquid chromatography were uniformly low. One double-strength tablet of trimethoprim-sulfamethoxazole taken weekly on Monday, Wednesday, and Friday appeared to be well tolerated and efficacious for the prophylaxis of PCP in HIV+ patients at high risk and deserves further investigation.
Authors:
D S Stein; R C Stevens; D Terry; S C Laizure; S Palte; D J Lancaster; J J Weems; C L Williams
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Antimicrobial agents and chemotherapy     Volume:  35     ISSN:  0066-4804     ISO Abbreviation:  Antimicrob. Agents Chemother.     Publication Date:  1991 Sep 
Date Detail:
Created Date:  1991-12-04     Completed Date:  1991-12-04     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  0315061     Medline TA:  Antimicrob Agents Chemother     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1705-9     Citation Subset:  IM; X    
Affiliation:
Department of Medicine, University of Tennessee, Memphis.
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MeSH Terms
Descriptor/Qualifier:
Adult
Chromatography, High Pressure Liquid
Complement C4 / isolation & purification
Drug Administration Schedule
Female
HIV Infections / drug therapy,  etiology*
Humans
Leucovorin / administration & dosage
Male
Pneumonia, Pneumocystis / prevention & control*
Prospective Studies
Sulfamethoxazole / administration & dosage*,  analogs & derivatives,  blood
Trimethoprim / administration & dosage*,  blood
Zidovudine / therapeutic use
Chemical
Reg. No./Substance:
0/Complement C4; 21312-10-7/N(4)-acetylsulfamethoxazole; 30516-87-1/Zidovudine; 58-05-9/Leucovorin; 723-46-6/Sulfamethoxazole; 738-70-5/Trimethoprim
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