Trimethoprim-sulfamethoxazole (TMP-SMX) is an effective treatment for Pneumocystis jirovecii pneumonia (PCP); however, a high incidence of adverse events has been observed. Low-dose TMP-SMX is a potentially effective treatment with fewer adverse events; however, evidence is limited. We aimed to evaluate the efficacy and safety of low-dose TMP-SMX after adjusting for patient background characteristics. In this multicentre retrospective cohort study, we included patients diagnosed with non-human immunodeficiency virus (HIV) PCP and treated with TMP-SMX between June 2006 and March 2021 at three institutions. The patients were classified into low- (TMP equivalent <12.5 mg/kg) and conventional-dose groups (TMP equivalent 12.5-20 mg/kg/day). The primary endpoint was 30-day mortality, and the secondary endpoints were 180-day mortality, adverse events of grade 3 or greater per the Common Terminology Criteria for Adverse Events Version 5.0, and initial treatment completion rates. The background characteristics were adjusted using the overlap weighting method with propensity scores. Fifty-five patients in the low-dose and 81 in the conventional-dose groups were evaluated. There was no significant difference in 30-day mortality (7.6% vs. 14.9%, P = 0.215) or 180-day mortality (18.1% vs. 24.0%, P = 0.416) after adjusting for patient background characteristics. The incidence of adverse events, especially nausea and hyponatremia, was significantly lower in the low-dose group (27.3% vs. 58.6%, P = 0.001). The initial treatment completion rates were 43.8% and 27.7% in the low-dose and conventional-dose groups, respectively. Low-dose TMP-SMX did not alter survival but reduced the incidence of adverse events in patients with non-HIV PCP, compared with conventional-dose TMP-SMX.
Background: In flexible bronchoscopy, endobronchial ultrasonography using a guide sheath (EBUS-GS) has varying diagnostic yields depending on the findings of radial-endobronchialultrasonography (R-EBUS). The diagnosis rate is lower when R-EBUS lesions are “adjacent to,” than when they are “within.” However, these findings are inconsistent and may change from “adjacent to” to “within” as the examination progresses (referred to as A to W). In this study, we analyzed the predictive factors for this change, which remain unexplored. Methods: This retrospective cohort study included patients who underwent flexible bronchoscopic biopsy with EBUS-GS at Kameda Medical Center between April 2014, and March 2019. Patients without “adjacent to” lesions were excluded. Based on multivariate regression results by drawing a receiver operating characteristic curve, we evaluated the discrimination properties of factors strongly correlated with “A to W”. Results:In total, 261 patients were included in this study. In 84 cases, R-EBUS findings were “adjacent to” to “within,” while in 177 cases, they were not. The mean lesion diameter was significantly larger (p = 0.021) in the group with “A to W” than in the group without it. The odds ratio (OR) for lesion diameter was significant in the multivariable regression model (OR: 1.024 [1.003-1.046]). The sensitivity and specificity were 0.346 and 0.853, respectively, at the optimal threshold (29.25 mm) set using the Youden index. Conclusion: In this study, we found that lesion diameter was a significant factor in predicting “A to W,” indicating a cutoff value of 29.25 mm with high specificity (0.853). Trial registration: The participants were registered retrospectively.
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