trimethoprim--sulfamethoxazole-drug-combination and Uremia

Topics: Aged; Caspofungin; Echinocandins; Humans; Leukemia, Myelomonocytic, Chronic; Lipopeptides; Male; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination; Uremia

Twenty-three stabilized chronic uremic patients with no active or recent infection were treated for 10 days with either cefodizime (5 x 2 g intravenously, n = 10) or cotrimoxazole (960 mg orally b.i.d., n = 8) in order to evaluate the effects on the depressed polymorphonuclear metabolic response to phagocytic challenge; a separate group of 5 patients received placebo. Ex vivo evaluation in whole blood of energy delivery to the phagocytosis-associated respiratory burst activity in response to latex and zymosan challenge was determined by measuring hexose-monophosphate shunt NAD(P)H-oxidase-related glycolytic activity. Cefodizime induced a statistically significant increase in the baseline-depressed glycolytic response for both latex and zymosan challenge, in contrast to cotrimoxazole and placebo. Depressed phagocytosis-related metabolic function in hemodialyzed patients was stimulated by cefodizime in recommended therapeutic doses but not by cotrimoxazole, the effect persisting for at least 2 weeks after the end of treatment.

Topics: Adult; Aged; Cefotaxime; Chronic Disease; Dose-Response Relationship, Drug; Energy Metabolism; Female; Glycolysis; Humans; Injections, Intravenous; Latex; Male; Middle Aged; NADH, NADPH Oxidoreductases; NADPH Oxidases; Neutrophils; Phagocytes; Phagocytosis; Renal Dialysis; Respiratory Burst; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Uremia; Zymosan

Nocardia farcinica has been reported as an increasingly frequent cause of localized and disseminated infections in immunocompromised patients in recent years, but N. farcinica bacteraemia remains a rare finding. Here, the case is described of a 68-year-old man with end-stage renal disease and idiopathic thrombocytopenia purpura treated with steroid therapy who developed disseminated infection (bacteraemia, multilobar pneumonia and brain abscesses) due to N. farcinica. The isolate was confirmed by partial sequencing analysis of the 16S rRNA gene. The patient recovered after prolonged trimethoprim-sulfamethoxazole therapy with no recurrence in over 1 year.

Topics: Aged; Bacteremia; Brain Abscess; DNA, Bacterial; DNA, Ribosomal; Humans; Male; Nocardia; Nocardia Infections; Pneumonia; Purpura, Thrombocytopenic, Idiopathic; RNA, Ribosomal, 16S; Sequence Analysis, DNA; Steroids; Trimethoprim, Sulfamethoxazole Drug Combination; Uremia

Trimethoprim-sulfamethoxazole (TMP-SMZ) and pentamidine are both licensed for the treatment of Pneumocystis carinii pneumonia (PCP). However, their use is associated with various adverse side effects. In this prospective study, 26 AIDS patients with 32 episodes of PCP were treated with pentamidine (4 mg/kg/d). Each patient was treated for 12 to 21 days, depending on the rapidity of onset of the clinical response. During the 32 PCP episodes, hypoglycemia occurred in 16 instances, azotemia in 12, liver toxicity in 10, and leukopenia in 8. The occurrence of thrombopenia, leukopenia, and liver toxicity was not related to age, pentamidine levels, or other complications. However, patients who had hypoglycemia during pentamidine treatment had higher serum pentamidine levels than patients who did not have hypoglycemia (107 +/- 40 versus 70 +/- 26 ng/ml, p less than 0.004). In addition, we observed that patients with azotemia showed higher pentamidine levels during treatment (120 +/- 35 versus 64 +/- 22 ng/ml, p less than 0.001). In fact, 100% (11/11) of patients with serum pentamidine concentration greater than 100 ng/ml had fasting hypoglycemia and/or azotemia, while 33% (7/21) of those with pentamidine levels less than 100 ng/ml had these side effects (p less than 0.001). The relative risk of these complications with pentamidine levels greater than 100 ng/ml was 3 (95% confidence interval, 1.6 to 5.5). Fine-tuning the dose of pentamidine may eventually prove useful to avoid toxicity and optimize therapy.

Topics: Acquired Immunodeficiency Syndrome; Adult; Analysis of Variance; Chi-Square Distribution; Female; Humans; Hypoglycemia; Male; Opportunistic Infections; Pentamidine; Pneumonia, Pneumocystis; Prospective Studies; Quebec; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Uremia