trimethoprim--sulfamethoxazole-drug-combination and Mycobacterium-avium-intracellulare-Infection

Topics: 2-Aminopurine; Acyclovir; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Anti-HIV Agents; Antifungal Agents; Antitubercular Agents; Antiviral Agents; Azithromycin; Chickenpox; Clarithromycin; Cytomegalovirus Infections; Drug Therapy, Combination; Famciclovir; Ganciclovir; Herpes Simplex; Humans; Mycobacterium avium-intracellulare Infection; Mycoses; Pneumonia, Pneumocystis; Rifabutin; Toxoplasmosis; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculosis, Pulmonary

Topics: Acyclovir; AIDS-Related Opportunistic Infections; Anti-HIV Agents; Anti-Infective Agents; Antitubercular Agents; Antiviral Agents; Atovaquone; Azithromycin; Chickenpox; Clarithromycin; Cytomegalovirus Infections; Drug Therapy, Combination; Ganciclovir; Herpes Simplex; Humans; Mycobacterium avium-intracellulare Infection; Naphthoquinones; Pneumonia, Pneumocystis; Rifabutin; Toxoplasmosis; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculosis, Pulmonary; Valacyclovir; Valine

Topics: 2-Aminopurine; Acyclovir; AIDS-Related Opportunistic Infections; Anti-Infective Agents; Antifungal Agents; Antiprotozoal Agents; Antiretroviral Therapy, Highly Active; Antitubercular Agents; Antiviral Agents; Atovaquone; Azithromycin; Clarithromycin; Cytomegalovirus Infections; Drug Therapy, Combination; Famciclovir; Herpes Simplex; Herpes Zoster; Humans; Mycobacterium avium-intracellulare Infection; Mycoses; Naphthoquinones; Pneumonia, Pneumocystis; Toxoplasmosis; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculosis, Pulmonary; Valacyclovir; Valine

Topics: Acquired Immunodeficiency Syndrome; Aerosols; Animals; Cryptococcosis; Cytomegalovirus Infections; Dapsone; Drug Combinations; Humans; Mycobacterium avium-intracellulare Infection; Opportunistic Infections; Pentamidine; Pneumonia, Pneumocystis; Pyrimethamine; Sulfadoxine; Toxoplasma; Toxoplasmosis; Trimethoprim, Sulfamethoxazole Drug Combination

A large number and variety of organisms can infect the lungs of persons with AIDS. An abnormal chest X-ray associated with pulmonary symptoms should trigger a vigorous search for an infectious agent. In many cases, if the patient is ambulatory, the workup can proceed on an outpatient basis. Pneumocystis carinii pneumonia is the most common infection and also one of the most readily treatable illnesses that these patients encounter. A careful and considered diagnostic approach is necessary to conserve the time and resources of both patients and healthcare providers.

Topics: Acquired Immunodeficiency Syndrome; Ambulatory Care; Cytomegalovirus Infections; Humans; Mycobacterium avium-intracellulare Infection; Mycoses; Opportunistic Infections; Pentamidine; Pneumonia; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculosis, Pulmonary

In 1995 and 1997, the United States Public Health Service (USPHS) and the Infectious Disease Society of America (IDSA) published recommendations for primary prophylaxis of Pneumocystis carinii pneumonia (PCP), Mycobacterium avium complex (MAC), and toxoplasmosis in HIV-infected adults. We evaluated their implementation at four hospital-based HIV clinics in New York City in patients who initially met the CD4+ criterion for prophylaxis between January, 1995 and April, 1997. Medical records were reviewed at 6-month intervals to determine drugs prescribed. We identified 149 patients for the PCP sample, 130 for MAC, and 138 for toxoplasmosis. In the three samples, 91% were black and Hispanic, 75% to 81% were male, and 43% to 47% had a history of injection drug use (IDU); median age was between 39 and 40 years. PCP prophylaxis was prescribed during 93% of intervals and did not vary significantly by clinic or patient characteristics. Over the study period, MAC prophylaxis increased from 22% to 62%, and prescriptions for macrolides increased from 38% to 87% of all prescriptions. In the logistic regression analysis, prescription for MAC prophylaxis at any time during the study period was less likely in blacks compared with whites (odds ratio [OR] = .08; 95% confidence interval [CI] = .01, .52) and patients attending the clinic with the lowest rate of MAC prophylaxis (clinic D) compared with the clinic with the highest rate (clinic B; OR = .04; 95% CI = .01, .26). Toxoplasmosis prophylaxis was prescribed in 73% of intervals and did not differ significantly by antibody status (p = .42). Prescribing patterns were uniform across gender, HIV risk behavior, and age for PCP and MAC prophylaxis but differed by clinic and race for MAC prophylaxis. Trends in prophylaxis for opportunistic illnesses must continue to be monitored in light of the success of antiretroviral therapy in reducing the morbidity and mortality associated with HIV/AIDS.

Topics: Adolescent; Adult; AIDS-Related Opportunistic Infections; Analysis of Variance; Anti-Infective Agents; Atovaquone; Azithromycin; Clarithromycin; Dapsone; Ethnicity; Female; HIV Infections; Humans; Longitudinal Studies; Male; Medical Records; Mycobacterium avium-intracellulare Infection; Naphthoquinones; New York City; Pentamidine; Pneumonia, Pneumocystis; Practice Guidelines as Topic; Regression Analysis; Rifabutin; Risk-Taking; Time Factors; Toxoplasmosis; Trimethoprim, Sulfamethoxazole Drug Combination; United States; United States Public Health Service

Topics: Acquired Immunodeficiency Syndrome; Aerosols; Animals; Cryptococcosis; Cytomegalovirus Infections; Dapsone; Drug Combinations; Humans; Mycobacterium avium-intracellulare Infection; Opportunistic Infections; Pentamidine; Pneumonia, Pneumocystis; Pyrimethamine; Sulfadoxine; Toxoplasma; Toxoplasmosis; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Anti-HIV Agents; Bone Marrow Diseases; Diarrhea; Duodenal Diseases; Edema; Enteral Nutrition; Humans; Hypotension; Leg; Male; Middle Aged; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Trimethoprim, Sulfamethoxazole Drug Combination

The objective of this study was to assess the factors implicated in an increased or decreased risk of pneumonia, with particular attention to the response to highly active antiretroviral therapy (HAART) and the effect of the polysaccharide 23-valent pneumococcal vaccination in 300 human immunodeficiency virus (HIV)-infected adults followed-up for a median of 35.6 months. Pneumococcal pneumonia occurred in 12 patients and all bacterial pneumonia (pneumonia caused by Streptococcus pneumoniae or other bacteria, as well as those with negative cultures but presumably bacterial in origin) in 40 patients. In the univariate analysis, immunodepressed patients (defined as those with less than 200 CD4+ T cell/microl), those without immunological response to HAART (defined as an increase of 25% of CD4+ T lymphocyte count), patients with previous admissions to hospital and those with cotrimoxazole or Mycobacterium avium intracellulare prophylaxis showed a higher incidence of both pneumococcal and all bacterial pneumonia. Multivariate analysis demonstrated that the presence of pneumococcal pneumonia was associated with a CD4+ lymphocyte count at the time of HIV diagnosis <200 cells/microl. The multivariate model that was more valid for prediction of all bacterial pneumonia included a CD4+ T cell count <200 cells/microl and absence of immunological response to HAART. Only in patients with a baseline CD4+ T cell count lower than 200/microl and immunological response to HAART, a near significant lower incidence of all bacterial pneumonia was observed after vaccination. Thus, these results do not support an important additional protective effect of 23-valent pneumococcal vaccine in HIV-patients with immunological response to HAART.

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; CD4 Lymphocyte Count; Female; HIV Infections; Humans; Immunity; Incidence; Male; Mycobacterium avium-intracellulare Infection; Pneumococcal Vaccines; Pneumonia, Bacterial; Pneumonia, Pneumococcal; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

HIV-associated infections in sub-Saharan Africa differ markedly in their incidence from those in industrialized countries. Tuberculosis is the commonest cause of morbidity and mortality. Enteric pathogens such as microsporidiosis commonly cause disease as access to safe water is limited. Pneumocystis carinii pneumonia, which is the commonest opportunistic infection in industrialized countries, is uncommon in adults with HIV infection. This remains unexplained because P. carinii pneumonia is common in Black African HIV-infected children. Cytomegalovirus and Mycobacterium avium complex, which only occur in severely immune-suppressed individuals, are seldom found. One reason may be that survival after conversion to AIDS is relatively short in Africa. Patients often die before they develop severe immune suppression. Recently, prophylactic cotrimoxazole treatment was shown to be effective in symptomatic HIV-infected adults in Africa. Tuberculosis preventive therapy is also effective in Africa, at least in the medium term. It is hoped that these two affordable interventions will become available to large numbers of patients identified in voluntary counselling and testing centres.

Topics: Adult; Africa; Africa South of the Sahara; AIDS Serodiagnosis; AIDS-Related Opportunistic Infections; Anti-Infective Agents; Antitubercular Agents; Black People; Child; Cytomegalovirus Infections; Developed Countries; Developing Countries; HIV Seropositivity; Humans; Incidence; Microsporidiosis; Mycobacterium avium-intracellulare Infection; Pneumonia, Pneumocystis; Survival Rate; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculosis

Topics: Dapsone; Humans; Mycobacterium avium-intracellulare Infection; Pentamidine; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination

As more drugs are approved for the prevention of opportunistic infections, concerns regarding the benefits and potential risks of these therapies are arising. A synopsis of the data for prophylaxis against opportunistic infections is provided for the following: Pneumocystis carinii pneumonia, fungal infections, Mycobacterium avium complex, cytomegalovirus infections, and toxoplasmosis. General precautions in using preventive medications for people with fewer than 100 CD4 plus cells are highlighted.

Topics: Acyclovir; AIDS-Related Opportunistic Infections; Clarithromycin; Clindamycin; Clinical Trials as Topic; Clotrimazole; Cytomegalovirus Infections; Dapsone; Fluconazole; Ganciclovir; Humans; Itraconazole; Leucovorin; Mycobacterium avium-intracellulare Infection; Mycoses; Pentamidine; Pneumonia, Pneumocystis; Pyrimethamine; Rifabutin; Toxoplasmosis; Trimethoprim, Sulfamethoxazole Drug Combination; Valacyclovir; Valine

Dr. Bernard Bihari, an AIDS specialist practicing in New York City, and other members of the Community Programs for Clinical Research on AIDS (CPCRA), have determined that some of the Public Health Services's recommendations for preventing opportunistic infections do not match the standards of care that the CPCRA developed nearly five years ago. The basic treatments provided by Bihari include using 1) TMP-SMZ and fluconazole to prevent, respectively, Pneumocystis carinii pneumonia (PCP) and cryptococcal meningitis in patients with CD4 counts below 200; 2) using high-dose acyclovir to prevent cytomegalovirus disease when the CD4 counts drop below 150; and 3) using clarithromycin and ethambutol to prevent Mycobacterium avium complex when CD4 counts drop below 100. This protocol has kept many patients from developing these opportunistic infections. Bihari notes that while the Centers for Disease Control and Prevention (CDC) recommendations are based on FDA-approved treatments and large clinical trials, private practitioners do not necessarily have to follow them.

Topics: AIDS-Related Opportunistic Infections; CD4 Lymphocyte Count; Clarithromycin; Cytomegalovirus Infections; Ethambutol; Humans; Meningitis, Cryptococcal; Mycobacterium avium-intracellulare Infection; New York City; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination

We report the successful treatment of disseminated Mycobacterium intracellulare osteomyelitis, without evidence of other visceral involvement, in a previously healthy, HIV-negative, 2-year-old female using a 23-month regimen of antimicrobial agents that included 18 months of oral therapy with azithromycin, rifabutin, trimethoprim-sulfamethoxazole (TMP/SMX), and ethambutol.

Topics: Azithromycin; Child, Preschool; Drug Therapy, Combination; Ethambutol; Female; Follow-Up Studies; HIV Seronegativity; Humans; Immunocompetence; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Osteolysis; Osteomyelitis; Rifabutin; Trimethoprim, Sulfamethoxazole Drug Combination

An agar dilution method against trimethoprim, sulfamethoxazole, sulfisoxazole, and trimethoprim-sulfamethoxazole was used to test clinical isolates of Mycobacterium intracellulare (MI) and M. avium (MA) from both HIV-infected and non-infected patients. MI and MA isolates demonstrated similar susceptibility data and were inhibited by concentrations of sulfamethoxazole achievable in serum.

Topics: Adult; Aged; Aged, 80 and over; AIDS-Related Opportunistic Infections; Child; Child, Preschool; Drug Resistance, Microbial; Folic Acid Antagonists; Humans; Infant; Microbial Sensitivity Tests; Middle Aged; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Sulfamethoxazole; Sulfanilamides; Sulfisoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Humans; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-Infective Agents; Cytomegalovirus Infections; Drug Therapy, Combination; Female; Humans; Male; Mycobacterium avium-intracellulare Infection; Nursing Assessment; Pentamidine; Pneumonia, Pneumocystis; Toxoplasmosis; Trimethoprim, Sulfamethoxazole Drug Combination

Among patients infected with human immunodeficiency virus type 1 (HIV-1), early and widespread use of prophylactic regimens against Pneumocystis carinii is changing the pattern of illnesses related to the acquired immunodeficiency syndrome (AIDS).. We conducted a subcohort analysis of 844 men with AIDS (87 percent of whom have since died) from a prospectively followed cohort of 2592 HIV-1-infected homosexual men.. A total of 138 men received prophylaxis before the diagnosis of AIDS, but 39 (28 percent) nevertheless had P. carinii pneumonia at some time. Only four illnesses occurred more frequently in men who received P. carinii prophylaxis before the onset of AIDS: Mycobacterium avium complex disease, which developed in 33.4 percent, as compared with 17.3 percent of the 706 men who did not receive early prophylaxis; wasting syndrome (18.4 percent vs. 6.4 percent); cytomegalovirus disease (44.9 percent vs. 24.8 percent); and esophageal candidiasis (21.3 percent vs. 12.8 percent). Collectively, these four diseases accounted for the initial AIDS-related illness in 42.7 percent of those who received prophylaxis before the onset of AIDS, as compared with 10.7 percent of those who did not. During the three six-month periods before the diagnosis of AIDS (0 to 6, > 6 to 12, and > 12 to 18 months), the geometric mean CD4+ cell counts were 48, 87, and 147 per cubic millimeter, respectively, in men who received prophylaxis against P. carinii, as compared with 118, 211, and 279 per cubic millimeter in those who did not.. M. avium complex disease, esophageal candidiasis, wasting syndrome, and cytomegalovirus disease are more common in HIV-infected patients who have received prophylaxis against P. carinii than in those who have not. Prophylaxis may delay the first AIDS illness for 6 to 12 months.

Topics: Acquired Immunodeficiency Syndrome; AIDS-Related Opportunistic Infections; Candidiasis; CD4-Positive T-Lymphocytes; Cohort Studies; Cytomegalovirus Infections; Dapsone; Esophageal Diseases; HIV-1; Humans; Leukocyte Count; Male; Mycobacterium avium-intracellulare Infection; Pentamidine; Pneumonia, Pneumocystis; Prospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Zidovudine

Topics: Adult; Child; Humans; Microbial Sensitivity Tests; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination

Twenty clinical isolates of Mycobacterium avium-intracellulare were tested with amikacin and sulphamethoxazole for in-vitro susceptibilities. The MICs and MBCs of the former drug ranged from 8 to > 64 mg/L (median MIC: 64 mg/L, median MBC: > 64 mg/L). The MICs and MBCs of the latter drug were found to be > 256 mg/L. Each of eight patients with invasive pulmonary disease due to these organisms was treated with amikacin for six months and with cotrimoxazole (sulphamethoxazole-trimethoprim) for one year. Only one patient had sustained bacteriological conversion. Three patients showed a transient reduction of bacillary load during the period of amikacin administration. The rest all failed to show response. Thus sulphamethoxazole was found to have no activity against Mycobacterium avium-intracellulare, and amikacin has doubtful activity when used alone in treatment of M. avium-intracellulare infection.

Topics: Adult; Aged; Amikacin; Female; Humans; Lung Diseases; Male; Microbial Sensitivity Tests; Middle Aged; Mycobacterium avium; Mycobacterium avium-intracellulare Infection; Saliva; Sulfamethoxazole; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Humans; Male; Middle Aged; Mycobacterium avium-intracellulare Infection; Myelodysplastic Syndromes; Trimethoprim, Sulfamethoxazole Drug Combination