trimethoprim--sulfamethoxazole-drug-combination and Lung-Neoplasms

We report a case of Nocardia exalbida (N.exalbida)-induced pneumonia in a 70-year old Japanese man with lung cancer and radiation pneumonitis. He initially received doripenem (1.5 g/day) for pneumonia treatment, and N.exalbida was identified by a clone library analysis of bronchoalveolar lavage fluid obtained from the pneumonia lesion. The doripenem dosage was therefore increased to 3.0 g/day with adjunctive trimethoprim/sulfamethoxazole, and his pneumonia improved. N. exalbida is susceptible to antibiotics; thus, in nocardiosis, N. exalbida infection might be associated with a good response to treatment, although its clinical findings are non-specific and similar to those of other Nocardia infections.

Topics: Aged; Anti-Bacterial Agents; Doripenem; Drug Therapy, Combination; Humans; Lung Neoplasms; Male; Nocardia; Nocardia Infections; Opportunistic Infections; Radiation Pneumonitis; Trimethoprim, Sulfamethoxazole Drug Combination

Chemotherapy-induced neutropenia can cause fatal bacterial infections. Colony-stimulating factors (CSFs) are usually recommended as prophylaxis, while routine use of prophylactic antibiotics remains controversial. Based on our literature search in PubMed, quinolones and trimethoprim/sulfamethoxazole were the most frequently used prophylaxis, while CSFs were administered in 22.1% of patients. Lung cancer patients who received prophylactic antibiotics exhibited significantly fewer episodes of febrile neutropenia, fewer documented infections as well as shorter duration of related hospitalisations. Prophylactic use of wide spectrum antibiotics seems effective and should be considered as an alternative strategy in the prevention of chemotherapy-induced neutropenia in lung cancer patients.

Topics: Antibiotic Prophylaxis; Antineoplastic Agents; Colony-Stimulating Factors; Fever; Humans; Lung Neoplasms; Neutropenia; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Infection are part of the natural course of lung cancer but overall they are poorly understood. The clinical studies on which is based our knowledge often lack sufficient clinical and microbiological documentation of the infection. Nevertheless, infection is frequently caused by Gram+ pathogens, among which pneumococci remain common. When lung cancer patients are treated with chemotherapy, the resulting neutropenia predisposes further to infection; its spectrum is similar to what has been observed in other granulocytopenic patients. The frequency and severity of the infection depends mainly on the severity and duration of neutropenia. Cotrimoxazole prophylaxis in neutropenic patients with lung cancer has been found effective in several studies. As far as therapy of fever and/or infection in neutropenic lung cancer is concerned, it does not appear that it should be handled differently from febrile neutropenia in other chemotherapy treated neutropenic patients.

Topics: Anti-Infective Agents; Antineoplastic Agents; Gram-Positive Bacterial Infections; Humans; Lung Neoplasms; Neutropenia; Trimethoprim, Sulfamethoxazole Drug Combination

The European Lung Cancer Working Party (ELCWP) designed a 3-arm phase III randomised trial to determine the role of accelerated chemotherapy in extensive-disease (ED) small-cell lung cancer (SCLC). Eligible patients were randomised between the 3 following arms: (A) Standard chemotherapy with 6 courses of EVI (epirubicin 60 mg m(-2), vindesine 3 mg m(-2), ifosfamide 5 g m(-2); all drugs given on day 1 repeated every three weeks. (B) Accelerated chemotherapy with EVI administered every 2 weeks and GM-CSF support. (C) Accelerated chemotherapy with EVI and oral antibiotics (cotrimoxazole). Primary endpoint was survival. 233 eligible patients were randomised. Chemotherapy could be significantly accelerated in arm B with increased absolute dose-intensity. Best response rates, in the population of evaluable patients, were, respectively for arm A, B and C, 59%, 76% and 70%. The response rate was significantly higher in arm B in comparison to arm A (P = 0.04). There was, however, no survival difference with respective median duration and 2-year rate of 286 days and 5% for arm A, 264 days and 6% for arm B and 264 days and 6% for arm C. Severe thrombopenia occurred more frequently in arm B but without an increased rate of bleeding. Non-severe infections were more frequent in arm B and severe infections were less frequent in arm C. Our trial failed to demonstrate, in ED-SCLC, a survival benefit of chemotherapy acceleration by using GM-CSF support.

Topics: Administration, Oral; Adult; Aged; Anti-Bacterial Agents; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Small Cell; Endpoint Determination; Etoposide; Female; Granulocyte-Macrophage Colony-Stimulating Factor; Humans; Ifosfamide; Lung Neoplasms; Male; Middle Aged; Prognosis; Survival Rate; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Vindesine

The efficacy of the prophylactic administration of sulfamethoxazole/trimethoprim (ST) plus norfloxacin (NFLX) versus ST alone to prevent the development of bacterial infection during chemotherapy-induced leukopenia was compared in patients with lung cancer. Patients who underwent systemic chemotherapy were randomized into one of the prophylactic regimens when grade 3 or 4 leukopenia occurred. Prophylactic treatment was performed on 133 courses of leukopenia in 75 patients and the efficacy was evaluated on 127 of those courses after excluding those patients who demonstrated a fever within 24 h from the start of the prophylaxis. The number of patients who had leukopenia associated fever was two out of 63 (3.2%) with the ST plus NFLX regimen and 10 out of 64 (15.6%) with ST alone; the difference was statistically significant. The prophylactic use of ST plus NFLX was thus found to be more useful than ST alone for the treatment of chemotherapy-induced leukopenia in patients with lung cancer.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; Antineoplastic Combined Chemotherapy Protocols; Bacterial Infections; Carcinoma, Non-Small-Cell Lung; Carcinoma, Small Cell; Cisplatin; Drug Therapy, Combination; Female; Granulocyte Colony-Stimulating Factor; Humans; Leukopenia; Lung Neoplasms; Male; Middle Aged; Neoplasm Staging; Norfloxacin; Trimethoprim, Sulfamethoxazole Drug Combination

In 103 patients with small-cell lung cancer, we compared four courses of standard doses of Adriamycin (A) (Adria Laboratories, Columbus, Ohio), vincristine (V), and cyclophosphamide (C) with a regimen of increased doses of cyclophosphamide and to a lesser extent, Adriamycin. We found no significant difference in rate (22% v 21%) or median duration (seven v nine months) of complete remission. Patients not in complete remission after the four cycles of AVC received two courses of VP-16 (etoposide) and cisplatin: the complete remission rate increased to 49% and 48% respectively. Patients on the high-dose arm received co-trimoxazole prophylaxis; those on the standard arm did not. Patients on the high-dose arm had a higher incidence of neutropenia (nadir less than 500 cells/microL) but a lower incidence of infection for similar degrees of neutropenia. However, they also suffered more severe side effects of a different kind. Cotrimoxazole thus allowed for the administration of higher doses of chemotherapy to outpatients by protecting them from infection. However, the higher doses of cyclophosphamide and Adriamycin, did not improve treatment results, produced more severe side effects, and is not recommended.

Topics: Aged; Animals; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Small Cell; Cats; Cisplatin; Clinical Trials as Topic; Cyclophosphamide; Doxorubicin; Drug Combinations; Etoposide; Female; Humans; Infection Control; Lung Neoplasms; Male; Middle Aged; Nausea; Neutropenia; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Vincristine; Vomiting

An 82-year-old woman treated for advanced lung cancer with gefitinb was admitted to the emergency unit complaining of dyspnea. Chest computed tomography found abnormalities classified as possible diffuse COVID-19 pneumonia. RT-PCR for Sars-Cov-2 was twice negative. PCR for Pneumocystis jirovecii was positive on bronchoalveolar lavage. The final diagnosis was Pneumocystis jirovecii pneumonia. Therefore, physicians must be careful not to misdiagnose COVID-19, especially in cancer patients on small-molecule therapeutics like gefitinib and corticosteroids.

Topics: Aged, 80 and over; Antineoplastic Agents; COVID-19; Diagnostic Errors; Female; Gefitinib; Humans; Lung Neoplasms; Pneumocystis carinii; Pneumonia, Pneumocystis; SARS-CoV-2; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Cough; Diagnosis, Differential; Fever; Humans; Lung Neoplasms; Malaysia; Male; Melioidosis; Middle Aged; Neoplasms; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Weight Loss

Tsukamurella spp. are gram-positive rods that can be isolated from the environment in soil and moist areas. In rare instances, they are known to cause infections in immunocompromised hosts. We present the first reported case of Tsukamurella endocarditis in an immunocompromised patient who was successfully treated with a 6-week course of imipenem and trimethoprim-sulfamethoxazole.

Topics: Actinobacteria; Anti-Bacterial Agents; Antineoplastic Agents; Diagnosis, Differential; Endocarditis, Bacterial; Female; Humans; Imipenem; Immunocompromised Host; Lung Neoplasms; Middle Aged; Small Cell Lung Carcinoma; Trimethoprim, Sulfamethoxazole Drug Combination

We present the case of a human immunodeficiency virus (HIV)-infected patient who arrived at our emergency department with fever, headache and exertional dyspnea. Throughout their stay, a chest x-ray was taken and a rounded opacity in his left lung was observed. CT images showed same abnormality and also ground glass opacities were seen. Symptoms and images strongly suggested a pulmonary infection due to pneumocystis jirovecii, however a presence of a round lesion should always lead to neoplasia being suspected. We empirically started treatment based on trimethoprim and sulfamethoxazole. Once available, flexible bronchoscopy and bronchoalveolar lavage was performed and stained preparations from his respiratory specimens confirmed the diagnosis of pulmonary pneumocystis infection. Finally, after 4 days of antibiotic therapy, an important clinical improvement was documented; a new chest x-ray was performed and the previous rounded opacity was absent. This finding strongly suggested a case of round pneumonia.

Topics: Adult; Antifungal Agents; Diagnosis, Differential; Emergency Service, Hospital; HIV Infections; Humans; Lung; Lung Neoplasms; Male; Pneumocystis carinii; Pneumonia, Pneumocystis; Radiography, Thoracic; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Antineoplastic Agents; Antiretroviral Therapy, Highly Active; Carcinoma, Non-Small-Cell Lung; Cisplatin; Emtricitabine; Female; Heterocyclic Compounds, 3-Ring; HIV Infections; HIV-1; Humans; Lung Neoplasms; Middle Aged; Oxazines; Pemetrexed; Piperazines; Pneumocystis carinii; Pneumonia, Pneumocystis; Pyridones; Tenofovir; Tomography, X-Ray Computed; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Viral Load

Topics: Biopsy, Needle; Drug Therapy, Combination; Follow-Up Studies; Humans; Immunocompromised Host; Immunologic Deficiency Syndromes; Lung Neoplasms; Magnetic Resonance Imaging; Male; Meropenem; Middle Aged; Myasthenia Gravis; Nocardia; Nocardia Infections; Opportunistic Infections; Radiography, Thoracic; Risk Assessment; Severity of Illness Index; Syndrome; Thienamycins; Thymoma; Thymus Neoplasms; Tomography, X-Ray Computed; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

A 47-year-old, non-smoking woman was admitted to the National Tuberculosis and Lung Diseases Research Institute for diagnosis of progressive exertional dyspnoea and numerous small thin-walled, air-filled cysts equally distributed throughout both lungs revealed in HRCT (high resolution computed tomography) examination. Histological assessment of specimens obtained by open lung biopsy revealed proliferation of immature smooth muscle, showing the expression of the antigen HMB45. On this basis, diagnosis of lymphangioleiomyomatosis was established. The disease caused essential ventilation damage of the lungs (FEV1 1.34 L; 39.71% pred, VC 4.02 L; 94.96% pred, FEV1/ /VC 0.33-4 1.81% pred, DLCO 3.65 mmol/min/Kpa 38.35% pred).During the observation, despite the lack of immunological disorders, the patient developed Pneumocystis jiroveci pneumonia (PCP) that was treated with trimethoprimsulfamethoxazole. Lymphangioleiomyomatosis is a rare disease which results from a defect of TSC genes. The disease is not related to immunological defects or disorders. However, the considerable cystic destruction of the lungs can predispose the patient to opportunistic infections such as the one in the presented case.

Topics: Anti-Infective Agents; Female; Humans; Lung Neoplasms; Lymphangioleiomyomatosis; Middle Aged; Pneumonia, Pneumocystis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adrenal Cortex Hormones; Anti-Infective Agents; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Bendamustine Hydrochloride; Bevacizumab; Breast Neoplasms; CD4 Lymphocyte Count; Clinical Trials, Phase I as Topic; Dexamethasone; Erlotinib Hydrochloride; Female; Humans; Lung Neoplasms; Middle Aged; Neoplasm Recurrence, Local; Nitrogen Mustard Compounds; Paclitaxel; Pneumocystis carinii; Pneumonia, Pneumocystis; Quinazolines; Trimethoprim, Sulfamethoxazole Drug Combination

Pneumocystis pneumonia is a life-threatening infection in patients undergoing chemotherapy for solid malignancies.. A 49-year-old man developed gradually increasing dyspnoea while receiving pemetrexed as a third line treatment for an adenocarcinoma of the lung. The diagnosis of pneumocystis pneumonia was based on ground-glass opacities on the thoracic CT scan and alveolar lavage revealing occasional cysts of Pneumocystis jiroveci in the context of recent lymphopenia developing during chemotherapy. Treatment with cotrimoxazole for three weeks was only partially successful due to progression of the tumour.. Pneumocystis pneumonia should be considered in cancer patients receiving antifolate drugs and presenting with increasing dyspnoea. It is important to identify a high-risk population among patients undergoing chemotherapy because of the significant morbidity and mortality and in order to administer effective prophylactic agents.

Topics: Adenocarcinoma; Antifungal Agents; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Bronchoalveolar Lavage Fluid; Disease Progression; Follow-Up Studies; Glutamates; Guanine; Humans; Infusions, Intravenous; Lung Neoplasms; Male; Middle Aged; Opportunistic Infections; Pemetrexed; Pneumocystis carinii; Pneumonia, Pneumocystis; Retreatment; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged; Anti-Bacterial Agents; Antineoplastic Combined Chemotherapy Protocols; Brain Neoplasms; Carcinoma, Small Cell; Ceftriaxone; Cisplatin; Combined Modality Therapy; Cranial Irradiation; Etoposide; Fatal Outcome; Female; Humans; Immunocompromised Host; Lung Neoplasms; Opportunistic Infections; Pneumonia, Pneumocystis; Pneumonia, Staphylococcal; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination

A case of pulmonary nocardiosis with empyema in a 55-year-old man with macroglobulinemic lymphoma is presented. Treatment with imipenem followed by oral trimethoprim-sulfamethoxazole (TMP-SMX) resolved his symptoms and cleared the roentgenographic abnormalities. This case illustrates the clinical potential of imipenem against Nocardia.

Topics: Drug Therapy, Combination; Empyema; Humans; Imipenem; Lung Diseases; Lung Neoplasms; Lymphoma; Male; Microbial Sensitivity Tests; Middle Aged; Nocardia asteroides; Nocardia Infections; Opportunistic Infections; Stomach Neoplasms; Trimethoprim, Sulfamethoxazole Drug Combination; Waldenstrom Macroglobulinemia

Topics: Acquired Immunodeficiency Syndrome; Anti-Bacterial Agents; Antifungal Agents; Bacterial Infections; Child; Child, Preschool; HIV Infections; Humans; Infant; Infant, Newborn; Lung Diseases; Lung Neoplasms; Mycoplasma Infections; Mycoses; Opportunistic Infections; Pneumonia, Pneumocystis; Pulmonary Fibrosis; Trimethoprim, Sulfamethoxazole Drug Combination; Virus Diseases

Topics: Aged; Carcinoma, Squamous Cell; Combined Modality Therapy; Drug Combinations; Hemoglobinuria, Paroxysmal; Humans; Lung Neoplasms; Male; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Between 1983 and 1985, 71 patients with the acquired immunodeficiency syndrome (AIDS) were evaluated. Pulmonary manifestations were present in 42 patients (59%). Pneumocystis carinii pneumonia (PCP) was the most common pulmonary manifestation, present in 32 patients (45%). Other pulmonary findings were cytomegalovirus pneumonia (one patient), Candida pneumonia (one patient), cryptococcal pneumonia (one patient), bacterial pneumonia (three patients), nonspecific pneumonitis (three patients), Kaposi's sarcoma (one patient), and non-Hodgkin's lymphoma (one patient). The presenting features of PCP were reviewed and in seven patients the chest X-ray and blood gases were normal at the time of diagnosis of PCP. Bronchoscopy was a safe and useful technique for obtaining specimens for diagnosis promptly, and a combination of samples obtained by bronchial washings/brushings and transbronchial biopsy was found to give a higher diagnostic yield than any single sample. Drug side-effects were common during therapy, requiring change of therapy in 16 patients. At one month after diagnosis 16% of patients with PCP had died. PCP is a common pulmonary manifestation in patients with AIDS which is treatable and has an initially favourable outcome.

Topics: Acquired Immunodeficiency Syndrome; Adult; Bronchoscopy; Drug Combinations; Humans; Lung Diseases; Lung Neoplasms; Lymphoma, Non-Hodgkin; Male; Middle Aged; Pneumonia, Pneumocystis; Sarcoma, Kaposi; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Fifteen patients undergoing intensive chemotherapy for oat cell carcinoma of the lung in a protected environmental unit received antimicrobial prophylaxis with oral trimethoprim-sulfamethoxazole and short courses of parenteral ticarcillin, tobramycin, and miconazole. Altogether, 58 (65%) of 89 strains of aerobic bacteria and 28 (60%) of 47 strains of anaerobic bacteria present before prophylaxis were no longer cultured from stool specimens during prophylaxis. Ten strains of bacteria and four fungi were acquired in the stools during prophylaxis. Most fungi persisted in the throat and stools during prophylaxis. Bacterial infections occurred infrequently, but three patients developed Candida esophagitis. The regimen was well tolerated with minimal side effects.

Topics: Adult; Aged; Anti-Bacterial Agents; Antineoplastic Agents; Bacteria; Bacterial Infections; Carcinoma, Small Cell; Digestive System; Drug Combinations; Female; Humans; Lung Neoplasms; Male; Miconazole; Middle Aged; Sulfamethoxazole; Ticarcillin; Tobramycin; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination