The pharmacokinetics of trimethoprim-sulfamet-hoxazole were studied in 12 healthy adult subjects receiving trimethoprim at 20 mg/kg of body weight per day and sulfamethoxazole at 100 mg/kg/day, which is the conventional dose for treating Pneumocystis cannii pneumonia (PCP). Daily doses were evenly divided and orally administered every 6 h for 3 days. Trimethoprim, sulfamethoxazole, and N4-acetylsulfamethoxazole concentrations in serum and urine were measured by high-performance liquid chromatography. Five subjects withdrew from the study because of intolerable gastrointestinal and central nervous system toxicities. In the seven subjects that completed the study, the mean maximum serum drug concentrations after the last dose were 13.6 ± 2.0, 372 + 64, and 50.1 10.9 ,ig/ml for trimethoprim, sulfamethoxazole, and N4-acetylsulfamethoxazole, respectively. The mean half-lives were 13.6 3.5, 14.0 2.3, and 18.6 4.3 h, respectively. Changes in absolute neutrophil count were significantly correlated with the minimum concentrations of trimethoprim and sulfamethoxazole in serum and trimethoprim area under the concentration-time curve (for all three parameters, r2 = 0.6 and P < 0.05). Our findings add to the evidence that serum drug concentrations in adults following the conventional dose of trimethoprim-sulfamethoxazole for PCP are excessive and contribute to certain adverse reactions. Further studies are indicated in patients to optimize the dosing regimen of trimethoprim-sulfamethoxazole in the treatment of PCP.Pneumocystis carinii pneumonia (PCP) is the most prevalent opportunistic infection in patients infected with human immunodeficiency virus type 1 (HIV), with over 80,000 cases reported since 1981 (3). This pneumonia accounts for 60% of the index diagnoses of AIDS, and approximately 80% of patients will develop an episode of PCP during their course of HIV infection (2). About 90% of patients with mild to moderate disease will respond with early initiation of therapy; however, in nearly 25% of patients, this pneumonia has been a major cause of mortality (13). Although widespread use of anti-pneumocystis pneumonia chemoprophylaxis will potentially reduce the incidence of PCP in HIVinfected patients, efforts focused on optimizing the acute management of this life-threatening infection nonetheless are warranted.Trimethoprim-sulfamethoxazole in a daily dose of 20 and 100 mg/kg of body weight, respectively, is a standard therapeutic modality for the treatment of PCP in AIDS patients, despite a greater than 60% incidence of adverse reactions during treatment (1,9,12,17,23 methoprim concentrations at 5 to 8 ,ug/ml decreased toxicity without an apparent diminution in efficacy. In addition, preliminary data indicate that maintaining the peak serum sulfamethoxazole concentration below 200 ,ug/ml may decrease the incidence of leukopenia (5).The current dosing recommendation of 20-mg/kg/day trimethoprim and 100-mg/kg/day sulfamethoxazole for treatment of PCP originated from studies in pediatric cancer patients (10,11). This repre...

This article reviews the literature on emergent literacy in young deaf children, focusing on the nature and course of both emergent reading and emergent writing. Beginning with definitions and background information concerning emergent literacy as a field of study, it examines instructional approaches that support emergent literacy learning. The review of the literature is organized into four major sections that reflect the body of work to date. The article concludes with an eye toward the future of emergent literacy in pedagogy, theory, and research.

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