Successful Chemoprophylaxis forPneumocystis cariniiPneumonitis

Abstract

In a randomized, double-blind, placebocontrolled study to evaluate the efficacy of trimethoprim-sulfamethoxazole for the prevention of Pneumocystis carinii pneumonia, we studied 160 patients with cancer who were at high risk for this pneumonia over a two-year period. Seventeen of the 80 patients receiving a placebo acquired P. carinii pneumonitis, whereas none of the 80 given 150 mg of trimethoprim and 750 mg of sulfamethoxazole per square meter per day had the infection P less than 0.01). Bacterial sepsis, pneumonia other than that caused by P. carinii, acute otitis media, upper-respiratory-tract infections, sinusitis and cellulitis occurred less frequently in recipients of the drug than in the placebo group (P less than 0.01 in each case). Oral candidiasis was the only adverse effect ecountered from trimethoprim-sulfamethoxazole administration. The study shows the combination to be highly effective in the prevention of P. carinii pneumonitis.

Antithymocyte globulin for steroid resistant rejection in renal transplant recipients immunosuppressed with triple therapy

“…We have previously shown that cotrimoxazole administered to prevent Pneumocystis caring pneumonia increases the risk of leucopenia in patients receiving triple therapy [9], and it is possible that it contributed to the leucopenia seen after ATG treatment in this series. In patients who are at high risk of developing leucopenia during ATG therapy, it may be desirable to give cotrimoxazole on just 4 consecutive days a week, as it has been shown that this regimen provides effective protection against Pneumocystis pneumonia [10]. The consistency of the haematological effects over the 3-year period of this study also suggests that there has been little batchto-batch variation in the preparation of the ATG used.…”

Randomized Trial of Weekly Sulfadoxine/Pyrimethamine vs. Daily Low‐Dose Trimethoprim‐Sulfamethoxazole for the Prophylaxis ofPneumocystis cariniiPneumonia After Liver Transplantation

“…Thirteen patients (22%) died in the trimethoprimsulfamethoxazole group for the following reasons: bacterial infection (6), hepatitis virus reinfection (4), invasive aspergillosis (2), and cerebral hemorrhage (1). Twelve patients (20%) died in the sulfadoxine/pyrimethamine group as follows: bacterial infection (8), invasive aspergillosis (1), and hepatitis virus reinfection (3).…”

“…PCP is clearly an infection to be prevented rather than treated. The prophylactic drug most commonly used is trimethoprim-sulfamethoxazole, and it has become a part of the standard care at many transplant centers [7][8][9][10][11][12][13].See editorial response by Gaut and Daar on pages 784 -6.In contrast with the quantity of experience accumulated with trimethoprim-sulfamethoxazole prophylaxis, the effectiveness of alternative prophylactic strategies, including weekly regimens, has not been studied in persons without HIV infection. In an attempt to reduce daily medication, and taking into account the safety and efficacy of weekly sulfadoxine/pyrimethamine that some authors have observed for HIV-infected patients [14], we thought that a prospective, randomized trial to determine the efficacy and safety of weekly sulfadoxine/pyrimethamine was justified.…”

“…PCP is clearly an infection to be prevented rather than treated. The prophylactic drug most commonly used is trimethoprim-sulfamethoxazole, and it has become a part of the standard care at many transplant centers [7][8][9][10][11][12][13].…”

Treatment of Pneumocystis carinii pneumonia with 1,3-beta-glucan synthesis inhibitors.

“…Pentamidine was effective in controlling the development of P. carinii pneumonia, but its associated toxicity made the need for a safer treatment apparent (4). The use of pentamidine for treating P. carinii pneumonia was virtually eliminated by the mid-1970s when it was discovered that a combination of trimethoprim (TMP) and sulfamethoxazole (SMZ) administered orally was equally as effective in treating P. carinii pneumonia, with minimal adverse reactions in non-AIDS patients (5). However, a majority ofAIDS patients with P. carinii pneumonia cannot tolerate TMP/SMZ, and the only alternative has been to return to the use of pentamidine, which has a slightly lower incidence of adverse reactions.…”