Effectiveness of cotrimoxazole prophylaxis on mortality in adults with tuberculosis in rural South Africa

Abstract

Cotrimoxazole prophylaxis for all adults with TB, irrespective of HIV status, in an area of high HIV seroprevalence may be a feasible, safe and effective way to reduce mortality for the duration of treatment.

Scaling-up co-trimoxazole prophylaxis in HIV-exposed and HIV-infected children in high HIV-prevalence countries

“…It has a broad-spectrum prophylactic action against common bacterial pathogens, Pneumocystis jirovecii (formerly Pneumocystis carinii) , and protozoa such as Plasmodium spp and Isospora belli. Randomised controlled trials (RCTs) 9,10 and studies with historical controls [11][12][13][14][15][16] in HIVinfected African adults consistently show signifi cant benefi ts in survival for those receiving co-trimoxazole prophylaxis. These improvements in survival have been accompanied by substantial reductions of severe disease events and the number of hospital admissions linked to invasive bacterial disease, pneumonia, malaria, and diarrhoea, although disease-specifi c benefi t has varied between studies.…”

“…Since then, several studies have shown that co-trimoxazole prophylaxis improves survival and reduces serious disease events even in areas of Africa where in-vitro cotrimoxazole resistance is common. [12][13][14][15][16][17] Furthermore, although resistance levels increase with time, as they have in Abidjan, this has not prevented the drug from being useful. 18 Co-trimoxazole's effi cacy against pneumocystis, isospora, and malaria might explain its favourable eff ects on morbidity and survival in endemic areas.…”

Implementation of co-trimoxazole prophylaxis and isoniazid preventive therapy for people living with HIV

“…The value of co-trimoxazole in reducing the morbidity and mortality associated with HIV infection has been well established through clinical trials conducted in industrialized 5,6 and developing countries. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] CTXp is associated with a 25-46% reduction in mortality among individuals infected with HIV in sub-Saharan Africa, even in areas with high bacterial resistance to the antibiotic. These improvements in survival have been accompanied by substantial reductions in severe disease events and in the number of hospital admissions linked to invasive bacterial disease, pneumonia, malaria and diarrhoea.…”

Causes of Death in HIV-infected Persons Who Have Tuberculosis, Thailand

“…The reported reduction in death rates from this intervention is large in Africa, but less so in Asia. (2,5,16,(20)(21)(22)(23). No published studies have demonstrated an association between CPT and reduced death rates in HIV-infected TB patients in Asia in the era of antiretroviral therapy (ART) (2,16; US Centers for Disease Control and Prevention [CDC], unpub.…”