trimethoprim--sulfamethoxazole-drug-combination and Kidney-Diseases

The role of antimicrobial prophylaxis for the prevention of recurrent urinary tract infections in children with vesicoureteral reflux that was identified following a urinary tract infection has been the source of considerable debate. Prior studies had failed to show a benefit in the prevention of recurrent infection. The National Institutes of Health funded the Randomized Intervention for Vesicoureteral Reflux (RIVUR) study to determine if there was a benefit to the use of prophylaxis. Results of the RIVUR study indicated that there was a 50% reduction in the risk of recurrent urinary tract infection in those children on the prophylaxis arm. Adverse events with the use of prophylaxis were noted to be few. Renal scarring was noted in only a small number of children at study entry and no reduction in scarring was noted between the placebo and the treated groups. The impact of the RIVUR study on the current evaluation and management of children with urinary tract infections and vesicoureteral reflux is detailed.

Topics: Anti-Bacterial Agents; Child, Preschool; Cicatrix; Humans; Infant; Kidney Diseases; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

High-dose corticosteroids in combination with cytotoxic drugs are universally accepted as the initial approach in vasculitides that are associated with anti-neutrophil cytoplasmic antibodies. Cyclophosphamide is the most effective cytotoxic drug and is used in more severe cases. Because cyclophosphamide has more severe short- and long-term side-effects than methotrexate, methotrexate is used in less severe cases. New prospects for the treatment of vasculitis include novel immunosuppressive agents (e.g. mycophenolate, 15-deoxyspergualin, and leflunomide), sequential chemotherapy (e.g. cyclophosphamide followed by azathioprine or cyclophosphamide followed by methotrexate), intravenous immunoglobulin, tumour necrosis factor-alpha directed therapy, anti-lymphocyte directed therapy (e.g. antithymocyte globulin or anti CD52/anti CD4 antibodies), anti-adhesion molecule directed therapy (e.g. anti-CD18 or intercellular adhesion molecule-1 antisense) or immunoablation using high-dose cytotoxic medication with or without stem cell rescue.

Topics: Antibodies, Antineutrophil Cytoplasmic; Antilymphocyte Serum; Cyclophosphamide; Guanidines; Humans; Immunoglobulins, Intravenous; Immunosuppressive Agents; Intercellular Adhesion Molecule-1; Isoxazoles; Kidney Diseases; Leflunomide; Methotrexate; Mycophenolic Acid; Prednisone; Remission Induction; Trimethoprim, Sulfamethoxazole Drug Combination; Tumor Necrosis Factor-alpha; Vasculitis

Antiinfective drugs may show the same mechanisms of nephrotoxicity as other drugs, and these can be subgrouped into vascular, tubulotoxic, tubulo-obstructive, and immunologic effects. While vascular effects of antiinfective drugs are rare, tubulotoxicity is a well known phenomenon, especially in connection with aminoglycosides and amphotericin B as well as cephalosporins, pentamidine, foscarnet, and cidovir. The tubulo-obstructive effect caused by precipitation of the drug and first observed after treatment with sulfonamides in the 1940s, has become a renascent problem now that high doses of sulfonamides are being given to immunocompromised patients (sulfadiazine, cotrimoxazole). Moreover, this effect has also been associated with newer antiviral drugs like acyclovir and indinavir. We describe a transplant patient who received high doses of cotrimoxazole for pneumocystis carinii pneumonia and lost transplant function mainly due to bioptically proven glomerular and tubular crystallization with tubular degeneration caused by sulfamethoxazole. Acute interstitial nephritis is the main immunologic effect of antiinfective drugs (especially rifampicin but also cephalosporins, quinolones, sulfonamides, and penicillins). Immune stimulation by cytokine treatment (mainly interferon-alpha) involves several kinds of autoimmune renal diseases like acute interstitial nephritis or glomerulonephritis as well as interstitial and vascular rejection of renal transplants.

Topics: Adult; Anti-Infective Agents; Autoimmune Diseases; Female; Glomerulonephritis; Humans; Kidney Diseases; Kidney Failure, Chronic; Kidney Glomerulus; Kidney Transplantation; Kidney Tubules; Nephritis, Interstitial; Pneumonia, Pneumocystis; Sulfamethoxazole; Trimethoprim, Sulfamethoxazole Drug Combination

Low-dose weekly pulse MTX therapy is effective for rheumatoid arthritis (RA) and is used for patients with RA who are unresponsive to conventional disease-modifying antirheumatic drugs (DMARDs). We used MTX to a 62-year-old man with RA who had received DMARDs for 5 years. MTX was effective for RA but after 12 weeks MTX therapy started, he complicated pancytopenia and developed Pneumocystis carinii pneumonia. We reviewed all RA patients reported in Japan and in the world from 1965, complicated with Pancytopenia (37 cases) and Pneumocystis carinii pneumonia (13 cases) after MTX therapy. Results were as following; (1) MTX should not be used with TMP-SMX. and risk factors for pancytopenia were (2) age over 60 years old (3) renal hypofunction (4) use of NSAID.

Topics: Age Factors; Anti-Infective Agents; Anti-Inflammatory Agents, Non-Steroidal; Antirheumatic Agents; Arthritis, Rheumatoid; Contraindications; Humans; Kidney Diseases; Male; Methotrexate; Middle Aged; Pancytopenia; Pneumonia, Pneumocystis; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acetylation; Adolescent; Chemical and Drug Induced Liver Injury; Cytotoxicity Tests, Immunologic; Hematologic Diseases; Humans; Kidney Diseases; Liver Diseases; Lymphocytes; Male; Phenotype; Skin Diseases; Thyroid Diseases; Trimethoprim, Sulfamethoxazole Drug Combination

This article reviews the pharmacokinetics, clinical use, and adverse effects of trimethoprim/sulfamethoxazole (TMP/SMX) in renally impaired patients. Renal dysfunction changes the pharmacokinetics of both component drugs. TMP and SMX disposition are not significantly altered until creatinine clearance is less than 30 mL/min, when SMX metabolites and TMP accumulate and may lead to toxicity. Renal dysfunction, however, does not preclude the use of TMP/SMX to treat susceptible infections, even when creatinine clearance is less than 15 mL/min. Adverse effects may occur more frequently in renally impaired patients but are not clearly related to increased serum concentrations of either drug. Guidelines for appropriate dosing and monitoring of TMP/SMX therapy in these patients are presented.

Topics: Humans; Kidney Diseases; Trimethoprim, Sulfamethoxazole Drug Combination

There has been intense discussion on the effectiveness of continuous antibiotic prophylaxis for children with vesicoureteral reflux, and randomized, controlled trials are still needed to determine the effectiveness of long-term antibiotics for the prevention of acute pyelonephritis. In this multicenter, open-label, randomized, controlled trial, we tested the effectiveness of antibiotic prophylaxis in preventing recurrence of pyelonephritis and avoiding new scars in a sample of children who were younger than 30 months and vesicoureteral reflux.. One hundred patients with vesicoureteral reflux (grade II, III, or IV) diagnosed with cystourethrography after a first episode of acute pyelonephritis were randomly assigned to receive antibiotic prophylaxis with sulfamethoxazole/trimethoprim or not for 2 years. The main outcome of the study was the recurrence of pyelonephritis during a follow-up period of 4 years. During follow-up, the patients were evaluated through repeated cystourethrographies, renal ultrasounds, and dimercaptosuccinic acid scans.. The baseline characteristics in the 2 study groups were similar. There were no differences in the risk for having at least 1 pyelonephritis episode between the intervention and control groups. At the end of follow-up, the presence of renal scars was the same in children with and without antibiotic prophylaxis.. Continuous antibiotic prophylaxis was ineffective in reducing the rate of pyelonephritis recurrence and the incidence of renal damage in children who were younger than 30 months and had vesicoureteral reflux grades II through IV.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Child, Preschool; Cicatrix; Female; Humans; Infant; Kidney Diseases; Male; Pyelonephritis; Trimethoprim, Sulfamethoxazole Drug Combination; Vesico-Ureteral Reflux

Questions have been raised regarding the safety of trimethoprim-sulfamethoxazole (TMP-SMZ) in organ transplantation, particularly adverse interactions with azathioprine and cyclosporine. In a prospective randomized, double-blind, trial in 132 patients that encompassed 33,876 patient-days, long-term prophylaxis with TMP-SMZ was found to significantly reduce the incidence of bacterial infection after renal transplantation. Prophylaxis was very well tolerated; none of the 66 recipients of TMP-SMZ, who took the drug for an average of 8.9 months, was withdrawn from the study because of hypersensitivity or toxic side effects. Serial measurements of hematologic parameters and liver function tests after transplantation in the two groups showed no significant differences. Recipients of cadaveric transplants, who were all given cyclosporine, randomized to receive TMP-SMZ had serum creatinine levels approximately 15% higher than those in control patients receiving cyclosporine (p less than 0.01); comparison of renal function by 24-hour endogenous creatinine clearances and technetium 99m-labeled diethylenetriamine-penta-acetic acid glomerular filtration rates in 17 patients crossed over to the alternate treatment group for 7 weeks, however, shows that the observed differences are reversible and represent inhibition of tubular excretion of creatinine by TMP in the presence of cyclosporine. Prophylaxis with TMP-SMZ had no discernable effect on cyclosporine pharmacokinetics: recipients of TMP-SMZ had blood levels of cyclosporine similar to those in patients in the placebo group. Episodes of graft rejection occurred at a similar frequency in the two groups (placebo, 50; TMP-SMZ, 44). We conclude that long-term prophylaxis with TMP-SMZ does not produce discernable hematologic, renal, or hepatic toxicity in renal transplant recipients nor does it augment nephrotoxicity with cyclosporine or increase the risk of rejection. TMP-SMZ may be used safely and is highly cost-beneficial for prophylaxis of infection in renal transplantation.

Topics: Creatinine; Cyclosporine; Double-Blind Method; Drug Interactions; Humans; Infections; Kidney Diseases; Kidney Transplantation; Patient Compliance; Postoperative Complications; Prospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination

To ascertain the efficacy and toxicity of trimethoprim-sulfamethoxazole or pentamidine when either is given alone during the entire treatment period for Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome (AIDS).. Prospective, randomized, noncrossover comparison of trimethoprim-sulfamethoxazole with pentamidine. Trimethoprim-sulfamethoxazole dosage was adjusted to maintain serum trimethoprim at 5 to 8 micrograms/mL. Pentamidine dosage was reduced by 30% to 50% for an absolute rise in serum creatinine of more than 88 mumol/L (1 mg/dL).. Tertiary care hospital and AIDS clinic.. Thirty-six patients were treated with trimethoprim-sulfamethoxazole and 34 with pentamidine. Pretreatment clinical features and laboratory test results were similar in the two groups.. Thirty-six recipients of trimethoprim-sulfamethoxazole and 33 recipients of pentamidine completed therapy without crossover. Trimethoprim-sulfamethoxazole caused a rash (44%) and anemia (39%) more frequently (P less than or equal to 0.03, whereas pentamidine caused nephrotoxicity (64%), hypotension (27%), or hypoglycemia (21%) more frequently (P less than or equal to 0.01). The (A - a)DO2 improved by greater than 1.3 kPa (10 mmHg) 8 days earlier for trimethoprim-sulfamethoxazole recipients (95% CI for the difference in response, -1 to 17; P = 0.04). Thirty-one (86%) patients treated with trimethoprim-sulfamethoxazole and 20 (61%) with pentamidine survived and were without respiratory support at completion of treatment (95% CI for the difference in response, 5% to 45%; P = 0.03).. For most patients with AIDS and P. carinii pneumonia, successful treatment with a single agent is possible. Toxicity associated with the two standard treatments is rarely life-threatening and may be diminished if the trimethoprim-sulfamethoxazole dosage is modified by pharmacokinetic monitoring and the pentamidine dosage is reduced for nephrotoxicity. Oxygenation improved more quickly and survival was better with trimethoprim-sulfamethoxazole.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amidines; Drug Combinations; Hematologic Diseases; Humans; Kidney Diseases; Male; Middle Aged; Pentamidine; Pneumonia, Pneumocystis; Prospective Studies; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Goodpasture Syndrome is described as a single episode disease entity. It is diagnosed with the demonstration of antiglomerular basement (anti-GBM) antibodies in plasma or renal tissue. Although the recurrence of anti-GBM disease is rare, it has been reported in up to 3% of cases. Recurrence with negative anti-GBM antibodies in plasma is even less frequent We report a 63 years old male in whom anti-GBM disease recurred without detectable anti-GBM antibodies in plasma, despite having positive antibodies at the onset.

Topics: Anti-Bacterial Agents; Anti-Glomerular Basement Membrane Disease; Autoantibodies; Biopsy; Cyclophosphamide; Fluorescent Antibody Technique; Humans; Kidney Diseases; Kidney Glomerulus; Male; Middle Aged; Prednisone; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Aged; Anti-Bacterial Agents; Chronic Disease; Crystallization; Humans; Kidney Diseases; Male; Pneumocystis carinii; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination

To identify the risk factors which will indicate the Pneumocystis carinii (Pc) infection in children with systemic lupus erythematosus (SLE) and investigate the clinical features and to elevate the level to find out the high-risk patients and make early diagnosis and treatment.. The characteristics, clinical features, laboratory examinations, treatment and prognosis of Pneumocystis carinii pneumonia (PCP) in children with SLE under 18 years of age treated in our hospital between January 2000 and January 2013 were prospectively reviewed. A comparison was made with the 26 cases of SLE children without PCP who were matched for gender, age and course, and a literature review was made.. (1) Five cases were enrolled, 3 were male and 2 female. Their age range was 13-17 (14.0 ± 1.6) years. All the children had kidney involvement. The courses were from 3 months to 4.5 years. All patients were receiving daily glucocorticoid therapy and immunosuppressive drugs before the diagnosis of PCP.Four patients were in the inactive phase of SLE (SLEDAI 2-4 points), and the fifth case was in active phase (SLEDAI 8, low complement 2 points, anti-dsDNA antibody positive 2 points, urine-protein 4 points). (2) Besides the clinical manifestations of SLE, most patients had progressive dyspnea, fever and dry cough at onset of PCP. Two children accepted mechanical ventilation because of respiratory failure. The mean duration of the symptoms to diagnosis was 10-30 (17.6 ± 7.8) days. Lactose dehydrogenase (LDH) was elevated more or less, median was (700 ± 263) U/L. Lymphocyte count were (0.3-1.4)×10(9)/L (median 0.5×10(9)/L), and three children had CD4 T lymphocyte count <0.3×10(9)/L. Arterial blood gas analyses showed severe hypoxemia. Chest radiographs showed in all cases diffuse interstitial infiltration. Pc was positive in the sputum. All patients were treated with trimethoprim-sulfamethoxazole and corticosteroids.. When SLE children are treated with corticosteroids and immunosuppressive drugs, low lymphocyte count is the risk factor for Pc infection.It is essential to monitor lymphocyte count.We should pay more attention to fever, dry cough and hypoxemia. Chest radiologic examination may help diagnose the PCP in SLE children.It may be helpful for SLE children whose CD4T lymphocyte was below 0.3×10(9)/L to take trimethoprim-sulfamethoxazole for PCP prophylaxis.

Topics: Adolescent; Anti-Infective Agents; Case-Control Studies; Child; Female; Glucocorticoids; Humans; Immunosuppressive Agents; Kidney Diseases; Lung; Lupus Erythematosus, Systemic; Lymphocyte Count; Male; Opportunistic Infections; Pneumonia, Pneumocystis; Prognosis; Retrospective Studies; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Child, Preschool; Drug Resistance, Microbial; Evidence-Based Medicine; Humans; Infant; Kidney Diseases; Pyelonephritis; Randomized Controlled Trials as Topic; Recurrence; Review Literature as Topic; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Acute Kidney Injury; Adenine; AIDS-Related Opportunistic Infections; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; Antitubercular Agents; Fatal Outcome; Humans; Kidney Diseases; Male; Middle Aged; Multiple Organ Failure; Organophosphonates; Pneumocystis carinii; Pneumonia, Pneumocystis; Recurrence; Renal Dialysis; Tenofovir; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculosis, Renal

We present a patient with Morbus Wegener and crescentic glomerulonephritis. Treatment with cyclophosphamide and prednisolone resulted in the disappearance of signs and symptoms of systemic inflammation. However, renal function deteriorated. Renal biopsy showed evidence of continuing capillary necrosis. Renal function improved with added plasmapheresis treatment. This case report illustrates that in patients with vasculitis necrotizing glomerulonephritis may remain active despite immunosuppressive therapy, even in the absence of extrarenal disease activity.

Topics: Aged; Cyclophosphamide; Disease Progression; Granulomatosis with Polyangiitis; Humans; Immunosuppressive Agents; Kidney Diseases; Male; Prednisolone; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

We conducted a retrospective study of AIDS-associated cerebral toxoplasmosis. Eighteen patients received pyrimethamine plus sulfadiazine and 25 co-trimoxazole, with comparable baseline characteristics. There were no differences in clinical outcomes, but co-trimoxazole was better tolerated (p = 0.066). There was also a trend towards more deaths among patients who received glucocorticoids.

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-Infective Agents; Antiprotozoal Agents; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Kidney Diseases; Male; Pyrimethamine; Retrospective Studies; South Africa; Sulfadiazine; Toxoplasmosis, Cerebral; Trimethoprim, Sulfamethoxazole Drug Combination

Indinavir is a widely prescribed protease inhibitor in the treatment of HIV infection. It has been associated with nephrolithiasis, crystalluria and tubulointerstitial nephritis. Nelfinavir is another protease inhibitor used successfully in AIDS treatment. The objective of this study was to evaluate the effect of both indinavir and nelfinavir individually, and in association with trimethoprim-sulfamethoxazole (TMP/SMX), on renal function in Wistar rats.. Doses of indinavir (80 mg/kg body weight [BW] daily), nelfinavir (75 mg/kg BW daily) and TMP/SMX (100 mg TMP/kg BW daily) were given by gavage for 15 days. Seven groups were studied: control, vehicle, TMP/SMX, indinavir, indinavir+TMP/SMX, nelfinavir, and nelfinavir+TMP/SMX.. No changes were observed in body weight, urine volume and blood pressure. The vehicle group did not differ from the control group. TMP/SMX induced a small decrease in inulin clearance with no tubular alterations. Indinavir decreased inulin clearance (indinavir: 0.48 +0.03 vs control: 0.93 +/- 0.08, P < 0.001) and renal blood flow (indinavir: 6.2 +/- 0.2 vs control: 8.0 +/- 0.3, P < 0.05). These effects were potentiated by TMP/SMX, which produced high vasoconstriction associated with alterations in tubular functions, characterised by increased fractional excretion of sodium (indinavir+TMP/SMX: 1.14 +/- 0.16 vs control: 0.39 +/- 0.07, P < 0.01). Nelfinavir either alone or in combination with TMP/SMX did not change the renal function of the rats.. These results suggest that indinavir nephrotoxicity in rats is potentiated by TMP/SMX and that nelfinavir alone or in combination with TMP/SMX is not nephrotoxic.

Topics: Animals; Anti-Infective Agents; Drug Interactions; Glomerular Filtration Rate; HIV Protease Inhibitors; Indinavir; Kidney Diseases; Male; Nelfinavir; Rats; Rats, Wistar; Renal Circulation; Trimethoprim, Sulfamethoxazole Drug Combination; Vasoconstriction

We describe a four-week-old male infant with bilateral renal parenchymal malakoplakia who presented with low grade fever, convulsions and lethargy. The patient had profound anemia, hepatosplenomegaly and bilateral nephromegaly with reduced renal function. Both blood and urine cultures grew Escherichia coli, and antibiotic therapy was started. A kidney biopsy obtained on the 20th hospital day confirmed the diagnosis of renal parenchymal malakoplakia. Following treatment with an intravenous methylprednisolone pulse therapy, the infant made significant clinical improvement. He has grown and developed normally in the three years following this episode. We suggest that the steroid therapy was useful in ameliorating renal parenchymal malakoplakia in a patient without an underlying systemic disease. This report describes the youngest patient to have malakoplakia.

Topics: Anti-Infective Agents, Urinary; Anti-Inflammatory Agents; Drug Administration Schedule; Humans; Infant; Kidney Diseases; Malacoplakia; Male; Methylprednisolone; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Cephalexin; Chemical and Drug Induced Liver Injury; Follow-Up Studies; Hematologic Diseases; Humans; Kidney Diseases; Skin Diseases; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The study involved 112 children with 169 confirmed vesicoureteric reflux grades I, II, III. During anti-bacterial treatment which lasted at last two years, spontaneous regression occurred in 82% of the vesicoureteral reflux. Renal scars were observed in 8% of the cases. Initially urinary tract infection was diagnosed in 84% of the children. This figure was reduced to 8% after anti-bacterial treatment. 54% of the observed children had associated diseases (anaemia, chronic enteropathy, bronchitis and pneumonia). The results confirmed the efficiency of anti-bacterial treatment in children with vesicoureteral reflux grades I, II, III.

Topics: Anti-Infective Agents, Urinary; Child; Child, Preschool; Female; Furagin; Humans; Kidney Diseases; Male; Remission Induction; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography; Vesico-Ureteral Reflux

Topics: Anti-Infective Agents, Urinary; Antimalarials; Humans; Kidney Diseases; Trimethoprim, Sulfamethoxazole Drug Combination

Hyperkalaemia with renal tubular dysfunction by oral therapy of sulfamethoxazole-trimethoprim (co-trimoxazole) is described in 2 elderly Japanese patients with lymphoid malignancy, who developed Pneumocystis carinii pneumonia and improved. A high dose of cotrimoxazole induced hyperkalaemia with the elevation of serum creatinine and blood urea, and increased urinary N-acetyl glucosaminase after several days of the drug administration in these patients; one patient became unconscious. Discontinuation of co-trimoxazole normalized serum potassium level and symptoms. A repeated low dose of the drug induced hyperkalaemia. Before the treatment of co-trixomazole, their serum levels of creatinine showed upper limits of normal ranges. In the present study, our cases suggested that patients receiving a high dose of co-trimoxazole should be evaluated for these potential complications during a course of treatment, particularly in elderly patients with preexisting renal dysfunction.

Topics: Aged; Humans; Hyperkalemia; Hyponatremia; Kidney Diseases; Kidney Tubules; Leukemia, T-Cell; Lymphoma, Non-Hodgkin; Male; Middle Aged; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Aged; Aged, 80 and over; Combined Modality Therapy; Creatinine; Cyclophosphamide; Cyclosporine; Female; Granulomatosis with Polyangiitis; Humans; Kidney Diseases; Lung Diseases; Male; Middle Aged; Plasmapheresis; Prednisolone; Retrospective Studies; Survival Rate; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Humans; Kidney Diseases; Pneumonia, Pneumocystis; Renal Dialysis; Trimethoprim, Sulfamethoxazole Drug Combination

From 1982 to 1987, 22 patients with proven Pneumocystis carinii pneumonia were diagnosed at Wellington Hospital. Patients comprised 15 males and 7 females aged 15-76 years and included seven with AIDS, eight with haematological malignancy and seven with renal disease. Two distinct clinical prodromes occurred. In renal patients a classic fulminating pneumonitis developed over 24 to 72 hours. In patients with AIDS a more indolent illness occurred lasting 3 or more weeks and was characterised by fever, dry cough and breathlessness. Haematology patients showed no specific duration of prodrome. At the time of diagnosis all had an abnormal chest radiograph and the arterial PO2 was reduced in all but one case. An invasive diagnostic procedure was performed in all except one case where the diagnosis was made at post mortem. Two patients required a second procedure to establish the diagnosis. Procedures performed included bronchoalveolar lavage [14], open lung biopsy [7] and transbronchial lung biopsy [2]. All patients were treated with high dose cotrimoxazole and 18 survived to leave hospital. A review of the approach to the diagnosis and treatment of Pneumocystis carinii pneumonia is presented.

Topics: Acquired Immunodeficiency Syndrome; Adolescent; Adult; Aged; Drug Combinations; Female; Humans; Immunologic Deficiency Syndromes; Immunosuppressive Agents; Kidney Diseases; Leukemia; Male; Middle Aged; Pneumonia, Pneumocystis; Prognosis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Basic glutathione transferase released from the proximal tubular epithelium in the kidney was monitored in the urine of 69 recipients of renal allografts. The enzyme was isolated from human liver and the urinary analysis performed with radioimmunoassay. Patients receiving cyclosporine A without toxicity or rejection did not excrete this enzyme in their urine; whereas the urine of patients with cyclosporine A-induced nephrotoxicity contained significant amounts of the transferase (P less than 0.001). Patients with allograft rejection also showed increased urinary concentrations of the basic glutathione transferase, but had significantly lower values than patients with cyclosporine induced nephrotoxicity (P less than 0.001). During aminoglycoside and co-trimoxazole treatment, the urinary concentration of this transferase also increased. Patients with renal infarction showed a sudden increase in urinary transferase to very high levels. The results indicate that quantitative analysis of the basic glutathione transferase in urine is useful for monitoring renal tubular lesions present in various complications following transplantation, such as cyclosporine and antibiotic induced nephrotoxicity and renal infarction.

Topics: Adolescent; Adult; Aged; Child; Clinical Enzyme Tests; Cyclosporins; Drug Combinations; Drug Therapy, Combination; Female; Glutathione Transferase; Graft Rejection; Humans; Kidney Diseases; Kidney Transplantation; Male; Middle Aged; Netilmicin; Postoperative Complications; Radioimmunoassay; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

High doses of co-trimoxazole in a patient with Pneumocystis carinii and impaired kidney function (creatinine clearance 10 ml/min) resulted in a declining renal clearance of the drug but did not affect the average creatinine clearance. The renal clearance of sulfamethoxazole and its metabolites 5-hydroxy-, N4-acetyl-, N4-acetyl-5-hydroxysulfamethoxazole decreased 80%, while the renal clearance of trimethoprim decreased 60%. The renal clearance of all compounds was evidently dependent on urine flow. The observed phenomena may be explained by the assumption that crystalluria occurred, obstructing kidney tubules. The crystalluria effect can be reversed by cessation of the drug or by lowering its dosage.

Topics: Adult; Anti-Infective Agents, Urinary; Drug Combinations; Humans; Kidney Diseases; Kinetics; Male; Pneumonia, Pneumocystis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Patients with normal and decreased kidney function were treated with an initial dose of 4 tablets Berlocombin and following with a dose of 2 tablets for 10 d in a 12 h period. The dialysis patients got only once the initial dose. The kinetic parameters were calculated by means of a one compartment model. Independend on the kidney function the minimum therapeutic serum concentrations of 1 microgram/ml at trimethoprime and of 20 micrograms/ml at the sulphonamides were reached during the first hours after medicament application. At all patients the urine concentration of trimethoprime were some times over the minimum therapeutic concentration. The individually found maintenance doses fluctuate between 2 tablets each 12 h and 1 tablet each 24 h. At patients with serum creatinine levels greater than 3 mg/100 ml (greater than 265 mumol/l) 1 tablet each 12 h is sufficient as maintenance dose. At a higher degree of kidney function decreasing (serum creatinine greater than 6 mg/100 ml (greater than 530 mumol/l] cumulating of the sulphonamide metabolites in the serum is found. The evaluated elimination velocity of the investigated sulphonamides during the hemodialysis was higher than that at patients with normal kidney function. The elimination rate of trimethoprime during the dialysis is in the same region as at patients without any kidney diseases.

Topics: Drug Combinations; Humans; Kidney Diseases; Kinetics; Renal Dialysis; Sulfamerazine; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Creatinine; Cyclosporins; Drug Combinations; Drug Interactions; Humans; Kidney Diseases; Kidney Transplantation; Male; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The belief that a favorable physiological milieu in the urinary tract may augment the effectiveness of antimicrobial agents used to treat urinary tract infections was examined by using an experimental model of Escherichia coli-induced renal infection in rats. The effect of manipulating urinary pH and flow on the antimicrobial activities of gentamicin, carbenicillin, ampicillin, nitrofurantoin and co-trimoxazole was assessed. In addition, a potential synergistic effect of the sequential administration of gentamicin and cephalothin in the eradication of renal infection was investigated. Although significant physiological alterations were achieved, these did not affect the efficacy of the antimicrobial agents studied, and therapeutic failures were common.

Topics: Ampicillin; Animals; Anti-Infective Agents, Urinary; Carbenicillin; Diuresis; Drug Combinations; Female; Gentamicins; Hydrogen-Ion Concentration; Kidney; Kidney Diseases; Nitrofurantoin; Rats; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urine; Urodynamics

A Sudanese girl became desperately ill with liver and kidney abscesses due to Nocardia asteroides. She did not have pulmonary or cutaneous infection. She recovered after surgical drainage of the abscesses and prolonged treatment with intravenous amikacin and high dosage cotrimoxazole and sulphadimidine. After recovery normal neutrophil function, cell-mediated and humoral immunity were demonstrated.

Topics: Abscess; Amikacin; Child; Drainage; Drug Combinations; Female; Humans; Kidney Diseases; Liver Abscess; Nocardia Infections; Sulfamethazine; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Drug Combinations; Humans; Kidney Diseases; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination