trimethoprim--sulfamethoxazole-drug-combination and Asthma

Topics: Adrenal Cortex Hormones; Antibodies, Monoclonal; Asthma; Drug Hypersensitivity; Food Additives; Food Hypersensitivity; Humans; Humidity; Hypersensitivity; Immunoglobulin E; Latex Hypersensitivity; Rhinitis; Trimethoprim, Sulfamethoxazole Drug Combination

Bacterial infections of the lower airways during an exacerbation in patients with asthma or chronic obstructive pulmonary disease (COPD) may be the cause of an exacerbation or the consequence of a viral infection or an increase in airways limitation. To determine whether bacterial infection is an important component in the pathogenesis of an exacerbation, the effects of antimicrobial treatment must be studied.. Patients with asthma or COPD seen in general practice were studied in a double blind randomised manner to investigate whether the antimicrobial drugs amoxicillin (500 mg three times daily), cotrimoxazole (960 mg twice daily), or a placebo, each when added to a short course of oral corticosteroids, can accelerate recovery from exacerbations. Patients were instructed to contact their own physician early in the morning when complaints of increased shortness of breath, wheezing, or exacerbations of cough with or without sputum production occurred. Treatment effects were evaluated over the next 14 days by studying symptom scores (wheeze, dyspnoea, cough with and without mucus production, and awakening with dyspnoea), peak expiratory flow values (PEF, expressed as % predicted), and sublingual temperature. Bacteriological study of the sputum was made at the onset of an exacerbation and 7, 21 and 35 days afterwards.. Of 195 patients enrolled 71 (36%) contacted their physician for symptoms of an exacerbation. Symptoms improved in all three groups, improvements ranging from 0.54 to 0.75 points per day on a four point scale. PEF% predicted showed improvements in the three groups after the exacerbation, ranging from 0.34% to 0.78% predicted per day, finally returning to baseline values. Sublingual temperature did not change. Six of 71 patients consulted their physician because of a relapse between four and 24 days after the start of treatment. In only two of the 50 sputum samples, collected during an exacerbation, and which contained > or = 10(5) bacteria in culture sensitive to the chosen antibiotic given, did any benefit from antimicrobial treatment occur. During the recovery period sputum purulence improved irrespective of antibiotic treatment.. Antibiotics given with a short course of oral prednisolone during an exacerbation do not accelerate recovery as measured by changes in peak flow and symptom scores in ambulatory patients with mild to moderate asthma or COPD when treated by their general practitioners. Moreover, antibiotics do not reduce the number of relapses after treating an exacerbation.

Topics: Amoxicillin; Anti-Bacterial Agents; Anti-Inflammatory Agents; Asthma; Bacterial Infections; Double-Blind Method; Drug Therapy, Combination; Family Practice; Female; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Penicillins; Prednisolone; Respiratory Function Tests; Respiratory Tract Infections; Smoking; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Infective Agents; Asthma; Child; Female; Humans; Lung; Male; Pneumocystis; Pneumocystis Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Anti-HIV Agents; Asthma; Betacoronavirus; Clinical Laboratory Techniques; Coronavirus Infections; COVID-19; COVID-19 Testing; Diagnosis, Differential; DNA, Bacterial; Emtricitabine; Glucocorticoids; HIV Infections; Humans; Lung; Male; Middle Aged; Multiplex Polymerase Chain Reaction; Oxygen Inhalation Therapy; Pandemics; Pneumocystis carinii; Pneumonia, Pneumocystis; Pneumonia, Viral; Prednisolone; Raltegravir Potassium; Real-Time Polymerase Chain Reaction; RNA, Viral; SARS-CoV-2; Tenofovir; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Viral Load

Pneumocystis jirovecii pneumonia (PCP) is an opportunistic infection in patients on steroid therapy for connective tissue diseases. The standard agent for primary PCP prophylaxis is trimethoprim/sulfamethoxazole (TMP-SMX), although this agent can cause common adverse reactions, including myelosuppression and renal toxicity, that result in cessation. Aerosolized pentamidine and oral atovaquone are alternatives for PCP prophylaxis. The efficacies of atovaquone, pentamidine, and TMP-SMX to prevent PCP in patients with connective tissue diseases have never been compared.. Hospitalized patients with connective tissue diseases who started steroid therapy and PCP prophylaxis were enrolled. PCP prophylaxis regimens were oral TMP-SMX, aerosolized pentamidine, or oral atovaquone. Information was retrospectively collected from medical records about laboratory findings, duration of PCP prophylaxis, and reasons for terminating PCP prophylaxis.. Ninety-six patients received PCP prophylaxis. All of them were initially treated with TMP-SMX, but this was replaced during the study period with pentamidine in 33 patients and with atovaquone in 7. Forty-one (43%) patients discontinued TMP-SMX because of adverse events, and 5 (15%) also discontinued pentamidine. None of the patients discontinued atovaquone. The most frequent causes of TMP-SMX and pentamidine cessation were cytopenia (N = 15) and asthma (N = 2). The rates of continuing treatment with TMP-SMX, pentamidine, and atovaquone at one year after starting PCP prophylaxis were 55.3%, 68.6%, and 100%, respectively (P = 0.01). None of the patients developed PCP.. Although TMP-SMX for PCP prophylaxis had to be discontinued in 43% of patients with connective tissue diseases, pentamidine and atovaquone were well tolerated.

Topics: Administration, Inhalation; Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Antibiotic Prophylaxis; Asthma; Atovaquone; Connective Tissue Diseases; Drug Therapy, Combination; Female; Hematologic Diseases; Humans; Male; Middle Aged; Opportunistic Infections; Pentamidine; Pneumocystis carinii; Pneumonia, Pneumocystis; Retrospective Studies; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

A 27-year-old man who had a history of bronchial asthma, eosinophilic enteritis, and eosinophilic pneumonia presented with fever, skin eruptions, cervical lymphadenopathy, hepatosplenomegaly, atypical lymphocytosis, and eosinophilia two weeks after receiving trimethoprim (TMP)-sulfamethoxazole (SMX) treatment. After the withdrawal of TMP-SMX and the administration of high-dose steroid, these systemic symptoms gradually resolved. During the disease course, the patient showed a transient increase in anti-human herpesvirus (HHV)-6 antibody titers and HHV-6 DNA in the peripheral blood, indicating the reactivation of a latent HHV-6 infection. This is the first case of TMP-SMX-induced hypersensitivity syndrome associated with the reactivation of a latent viral infection.

Topics: Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Antibodies, Viral; Asthma; DNA, Viral; Drug Eruptions; Enteritis; Glucocorticoids; Herpesvirus 6, Human; Humans; Male; Opportunistic Infections; Pulmonary Eosinophilia; Recurrence; Roseolovirus Infections; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Virus Activation

Topics: Adult; Asthma; Biopsy; Diagnosis, Differential; Erythema Nodosum; Exanthema; Female; Humans; Irritable Bowel Syndrome; Leg; Lymphatic Diseases; Mycobacterium tuberculosis; Pain; Radiography; Sarcoidosis; Skin; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculin Test; Tuberculosis, Pulmonary

In the case reported, serial evaluation of sputum inflammatory cell counts made it possible to identify an unusual series of events in a man with eosinophilic bronchitis. The patient initially presented with a productive cough, which did not respond to treatment with antibiotics or high-dose inhaled corticosteroids. A diagnosis of eosinophilic bronchitis was made after demonstration of intense sputum eosinophilia. When inhaled corticosteroids were stopped, symptoms and sputum eosinophilia became worse and airway hyperresponsiveness developed. Both abnormalities were reversed by a course of prednisone. When the prednisone was stopped the productive cough recurred but on this occasion sputum examination suggested a different disease process and the symptoms resolved after a course of co-trimoxazole. The patient has subsequently remained well on no treatment with little or no sputum eosinophilia.

Topics: Anti-Infective Agents; Anti-Inflammatory Agents; Asthma; Bronchial Hyperreactivity; Bronchitis; Budesonide; Cough; Diagnosis, Differential; Eosinophilia; Eosinophils; Glucocorticoids; Humans; Leukocyte Count; Male; Middle Aged; Neutrophils; Prednisone; Pregnenediones; Sputum; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged; Anti-Infective Agents; Asthma; Drug Combinations; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Pulmonary Emphysema; Status Asthmaticus; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination