Trimethoprim‐Sulfamethoxazole (TMP‐SMZ) Dose Escalation versus Direct Rechallenge for<i>Pneumocystis Carinii</i>Pneumonia Prophylaxis in Human Immunodeficiency Virus–Infected Patients with Previous Adverse Reaction to TMP‐SMZ

Leoung, Gifford S.; Stanford, James; Giordano, M; Stein, Allan; Torres, Ramón A.; Giffen, Carol; Wesley, Margaret N.; Sarracco, Tricia; Cooper, Ellen C.; Dratter, Valerie; Smith, Jennifer M.; Frost, Kevin R.

doi:10.1086/323353

Cited by 105 publications

(42 citation statements)

References 30 publications

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“…Two studies compared the effectiveness of induction of tolerance versus rechallenge (single dose) in HIV-positive patients with documented reactions to TMP-SMX, and there were no differences in the success rates. 31,32 These results place into question the validity of previously reported induction of tolerance procedures that did not include a control group of patients who received full-dose TMP-SMX.…”

Section: Sulfonamidesmentioning

confidence: 73%

Drug allergy

Khan

Solensky

2010

Journal of Allergy and Clinical Immunology

230

211

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Drug allergy is one type of adverse reaction to drugs and encompasses a spectrum of hypersensitivity reactions with heterogeneous mechanisms and clinical presentations. A thorough history is essential to the management of drug allergy. Laboratory testing has a very limited role in the management of drug allergy. Graded dose challenges and procedures to induce drug tolerance might be required in patients with drug allergy when there is a definite need for a particular agent. Management of reactions to specific agents, including beta-lactam antibiotics, sulfonamides, local anesthetics, radiocontrast media, angiotensin-converting enzyme inhibitors, nonsteroidal anti-inflammatory drugs, and biologic modifiers, will be discussed in further detail.

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Section: Sulfonamidesmentioning

confidence: 73%

Drug allergy

Khan

Solensky

2010

Journal of Allergy and Clinical Immunology

230

211

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“…Significantly, a large proportion of AALs were type A (23%), amendable to immediate "delabeling." In LTRs with a sulfonamide allergy, TMP-SMX or dapsone may also have been unnecessarily avoided if one considers that antibiotic sulfonamide cross-reactivity is lower than previously thought (5) and TMP-SMX desensitization or rechallenge is often effective (6,7).…”

mentioning

confidence: 99%

Antibiotic Allergy Labels in a Liver Transplant Recipient Study

Khumra

Chan

Urbancic

et al. 2017

Antimicrob Agents Chemother

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P atient-reported antibiotic allergies (so-called antibiotic allergy labels [AALs]) are associated with suboptimal prescribing and inferior clinical outcomes, especially in the immunocompromised (1, 2). The prevalence, type, and impact of AALs in liver transplant recipients (LTRs) remain ill defined. We report on AALs and their impact on a cohort of Australian LTRs.A retrospective matched-cohort study was conducted over a 5-year period (2010 to 2015) at an Australian liver transplant center (Austin Health). Using a departmental liver transplant database, LTRs with an AAL (AAL group) were identified. The same number of matched controls (LTRs without an antibiotic allergy label [non-AAL group]) were randomly selected for comparison. AALs were evaluated and classified as type A adverse drug reactions (ADRs; nonimmune mediated), type B ADRs (immune mediated), or of unknown type (3). Baseline demographics, transplant history, and infection-related admission data were collected. From the time of transplant until 12 months afterward, antibiotics administered during infection-related admissions and their duration of administration were recorded. Readmission, intensive-care unit (ICU) admission, Clostridium difficile infection (CDI), multidrug-resistant (MDR) organism isolation, and mortality rate were captured. An MDR organism was defined as a bacterium resistant to at least one agent in three or more antibiotic classes (4).Of 313 LTRs, 51 (16%) had Ն1 AAL. Females predominated in the AAL group (75% female versus 25% male; P ϭ 0.003), but there was no statistically significant differences in the rates of ICU admission and mortality between males and females (see Table S1 in the supplemental material). Seventy-seven AALs were recorded; of these, 23% (18/77) were type A ADRs, 66% were type B ADRs (51/77), and 10% (8/77) were of unknown type. Of the type A ADRs, 72% (13/18) were gastrointestinal upset, and of the type B ADRs, 6% (3/51) were severe cutaneous ADRs, 55% (28/51) were maculopapular exanthema, 35% (18/51) were anaphylaxis, urticaria, or angioedema, and 4% (2/51) were other reactions. The antibiotics implicated in AALs are demonstrated in Fig. 1

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“…Because of the advantages of TMP-SMX, desensitization of patients who are intolerant of TMP-SMX has been used for many HIV-positive patients (1,17,51,100). Two randomized controlled trial have shown that gradually increasing in the dose of TMP-SMX improves the tolerability of the drug in HIV-positive patients (129).…”

Section: Trimethoprim-sulfamethoxazolementioning

confidence: 99%

Prevention of Infection Due toPneumocystisspp. in Human Immunodeficiency Virus-Negative Immunocompromised Patients

2004

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Pneumocystis infection in humans was originally described in 1942. The organism was initially thought to be a protozoan, but more recent data suggest that it is more closely related to the fungi. Patients with cellular immune deficiencies are at risk for the development of symptomatic Pneumocystis infection. Populations at risk also include patients with hematologic and nonhematologic malignancies, hematopoietic stem cell transplant recipients, solid-organ recipients, and patients receiving immunosuppressive therapies for connective tissue disorders and vasculitides. Trimethoprim-sulfamethoxazole is the agent of choice for prophylaxis against Pneumocystis unless a clear contraindication is identified. Other options include pentamidine, dapsone, dapsone-pyrimethamine, and atovaquone. The risk for PCP varies based on individual immune defects, regional differences, and immunosuppressive regimens. Prophylactic strategies must be linked to an ongoing assessment of the patient's risk for disease

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Trimethoprim‐Sulfamethoxazole (TMP‐SMZ) Dose Escalation versus Direct Rechallenge forPneumocystis CariniiPneumonia Prophylaxis in Human Immunodeficiency Virus–Infected Patients with Previous Adverse Reaction to TMP‐SMZ

Cited by 105 publications

References 30 publications

Drug allergy

Drug allergy

Antibiotic Allergy Labels in a Liver Transplant Recipient Study

Prevention of Infection Due toPneumocystisspp. in Human Immunodeficiency Virus-Negative Immunocompromised Patients

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