trimethoprim--sulfamethoxazole-drug-combination and AIDS-Related-Complex

The purpose of this prospective randomized open trial was to investigate the impact of monitoring concentrations in serum on the efficacy and side effects of high-dose co-trimoxazole therapy. Forty consecutive patients with microscopically confirmed Pneumocystis carinii pneumonia were enrolled. Therapy was started with 5 and 25 mg of trimethoprim and sulfamethoxazole, respectively, per kg of body weight given every 6 h for 2 days and continued every 8 h either with (group A) or without (group B) monitoring and dose adjustments according to sulfamethoxazole levels in serum (target, 150 to 200 micrograms/ml) for a total of 21 days. Only 7 of 19 patients (83%). Patients who were treated for the full period and patients for whom co-trimoxazole was prematurely stopped had similar concentrations of sulfamethoxazole (157 +/- 52 versus 155 +/- 47 micrograms/ml) and trimethoprim (5.0 +/- 1.4 versus 5.6 +/- 1.0 microgram/ml). Concentrations of sulfamethoxazole and trimethoprim in group A (158 +/- 39 and 5.6 +/- 1.8 micrograms/ml, respectively) did not differ from those in group B (153 +/- 57 and 5.1 +/- 1.6 micrograms/ml, respectively), and the average daily maintenance doses for groups A (75.4 mg/kg plus 15.1 mg/kg) and B (76.4 mg/kg plus 15.3 mg/kg) were nearly identical. Although the average sulfamethoxazole concentrations were maintained within the target zone in the monitoring group (day 5, 160 +/- 44 micrograms/ml; day 10, 160 +/- 41 micrograms/ml; day 15, 168 +/- micrograms/ml; and day 21, 157 +/- 95 micrograms/ml), only 28% of the individual sulfamethoxazole levels were within the target range of 150 to 200 micrograms/ml after the dose adjustments (32% in group B without intervention). Response rates were similar in both groups. Complete response or improvement was observed in 18 of 19 (group A) and 19 of 21 (group B) patients. The method used for monitoring sulfamethoxazole levels with subsequent dose adjustment did not allow us to reliably achieve the target concentrations and did not significantly alter the incidence of side effects or the efficacy of the therapy.

Topics: Adolescent; Adult; AIDS-Related Complex; AIDS-Related Opportunistic Infections; Antifungal Agents; Female; Humans; Male; Pneumonia, Pneumocystis; Prospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination

To evaluate efficacy and toxicity of intermittent trimethoprim-sulfamethoxazole (T/S) prophylaxis for Pneumocystis carinii pneumonia (PCP) our HIV-positive patients were given T/S (160 mg, 800 mg) twice daily for 3 consecutive days per week. Patients were included only if they met the CDC criteria for PCP prophylaxis, did not have intolerance to T/S, and if follow-up was 3 or more months. Thirty-eight patients received primary prophylaxis (Group I) for a mean period of 18.1 months and 26 patients received secondary prophylaxis (Group II) for a mean period of 15.5 months. Seventeen patients had adverse reactions (14 minor and 3 major reactions). PCP occurred in 1 patient in Group I after 20 months of T/S, and in 2 patients in Group II after 11 and 18 months of T/S. This pilot study suggests that intermittent T/S treatment is efficacious and relatively safe in the prophylaxis for PCP in HIV-positive patients.

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS Dementia Complex; AIDS-Related Complex; Female; Humans; Male; Middle Aged; Pilot Projects; Pneumonia, Pneumocystis; Risk Factors; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

The efficacy and tolerability of low, intermittent doses of co-trimoxazole (160 mg trimethoprim and 800 mg sulfamethoxazole given Monday, Wednesday, Friday) for prophylaxis against Pneumocystis carinii pneumonia (PCP) was assessed retrospectively in 116 patients with the acquired immunodeficiency syndrome (AIDS) and AIDS-related complex at high risk of PCP. 92% were receiving concomitant zidovudine. 71 with previous episode(s) of PCP were followed a mean of 18.5 months (range 3-42). 45 without past PCP but with depletion of CD4 cells to less than 200/microliters were observed for a mean of 24.2 months (range 9-40). PCP did not develop in any patient on co-trimoxazole. 33 (28%) had side-effects, mainly rash, pruritus, and nausea. 15 discontinued co-trimoxazole, but only 11 (9%), who withdrew in the first month, were clearly drug-intolerant. Thus, low-dose, thrice weekly co-trimoxazole completely prevents AIDS-associated PCP, is cost-effective, and well tolerated by more than 85% of patients. Controlled comparisons of this regimen with other prophylactic agents are warranted.

Topics: Acquired Immunodeficiency Syndrome; Adult; Aged; AIDS-Related Complex; Drug Administration Schedule; Drug Evaluation; Female; Follow-Up Studies; Humans; Male; Middle Aged; Opportunistic Infections; Pneumonia, Pneumocystis; Recurrence; Retrospective Studies; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

12 AIDS/ARC patients with or suspected of Pneumocystis carinii pneumonia were treated with co-trimoxazole and received supplementary folic or folinic acid to avoid peripheral blood cytopenia. Most patients developed decreased numbers of neutrophils and hemoglobin while receiving co-trimoxazole. Supplementary folate/folinate could not abolish the drug-induced cytopenia. Routine prescription of folinic acid is not recommended. Folic acid is cheap and may be beneficial and should be prescribed.

Topics: Acquired Immunodeficiency Syndrome; AIDS-Related Complex; Anemia; Drug Combinations; Folic Acid; Hematologic Diseases; Humans; Leucovorin; Leukopenia; Pneumonia, Pneumocystis; Prospective Studies; Sulfamethoxazole; Thrombocytopenia; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination