Efficacy of Sulfamethoxazole-Trimethoprim Administration in the Prevention of Pneumocystis carinii Pneumonia in Patients with Connective Tissue Disease

Abstract

The efficacy and adverse effects of prophylactic administration of Sulfamethoxazole-Trimethoprim (ST) for Pneumocystis carinii Pneumonia (PCP) were assessed in patients with connective tissue diseases (CTD) Eightly four patients who were receiving more than 40mg/day of prednisolone were entried in the present study. Patients with at least one of the two PCP risk factors (interstitial pulmonary fibrosis and lymphopenia) , were administred either one (11 patients) or two (26 patients) ST tablets/day. The remaining 47 patients who did not receive ST served as the controls. Although PCP was detected in 4.3% of the patients in the no-ST group, none of the patients who received ST developed PCP. Five of these 26 patients who received two tablets of ST/day, experienced adverse reactions. However, no adverse reactions were detected in the patients who received one tablet of ST/day (p<0.05). Abnormal laboratory data were obtained for 10 (38.5%) of the patients who received two tablets of ST/day and for 4 (36.4%) of the 11 patients who received one tablet of ST/day. The results of the present study suggest that the prophylactic administration of one tablets of ST in patients with CTD that have at least one of the two PCP risk factors is effective in preventing PCP.

Clinical characteristics of Pneumocystis carinii pneumonia in patients with connective tissue diseases

“…17 Routine primary prophylaxis was not introduced until February 2001 in our department because the incidence of PCP had been extremely low. Since the latter half of 2001, however, we have prescribed 80 mg of TMP and 400 mg of SMX daily for PCP prophylaxis to patients older than 50 years at the start of high-dose steroid or immunosuppressant therapy.…”

“…[9][10][11][12]15,16 Primary prophylaxis for PCP was effective in patients with CTDs receiving steroid therapy. 17 In this study, we retrospectively analyzed the clinical characteristics, laboratory data, radiological findings, treatment courses, and outcomes of PCP in patients with CTDs to determine whether these patients have any characteristics different from those of HIV patients with PCP.…”

Pneumocystic Pneumonia in Rheumatic Diseases: Current Issues in Prophylaxis

“…Однако в отношении ГК как наиболее часто применяемых препаратов остается нерешенным вопрос: какая все-таки доза повышает риск ППн -средняя, суточная, пульсовая или кумулятивная [10,17,18]. Согласно различным источникам, в зависимо-сти от категории больных суточная доза ГК (в пересчете на преднизолон), способствующая развитию ППн, колеблется от >15 мг до > 40 мг [2,15,[19][20][21]. По данным клиники Мейо, доза 30 мг/сут в преднизолоновом эквиваленте рас-сматривается как ключевой фактор риска ППн.…”

“…В ретроспек-тивной работе P. Vanonuvat и соавт., включавшей 132 больных с воспалительными РЗ (СКВ, ДМ, болезнь Бехчета, васкулит), назначение профилактики ко-тримо ксазолом привело к снижению абсолютного риска развития ППн на 7,3% [31]. Подобное снижение риска наблюдали и в других ретроспективных исследованиях [15,19]. В то же время в популяциях больных с ВИЧ-инфекцией и без таковой про-филактическое назначение ко-тримоксазола ассоциирует-ся с широким спектром нежелательных реакций (НР), которые могут быть серьезными и даже угрожающими жизни.…”

Prevention of Infection Due to Pneumocystis spp. in Human Immunodeficiency Virus-Negative Immunocompromised Patients

“…TMP-SMX is effective in reducing the incidence of PCP in patients with connective tissue diseases with either lymphopenia or interstitial pulmonary fibrosis (123). Drug interactions with other hematopoietic suppressants, including allopurinol, azathioprine, mycophenolate mofetil, and methotrexate, are common, and patients should be monitored very closely for toxicity if one of these agents is given together with TMP-SMX (22,155).…”