Oral Therapy for<i>Pneumocystis carinii</i>Pneumonia in the Acquired Immunodeficiency Syndrome

Medina, Ileana; Mills, John; Leoung, Gifford S.; Hopewell, Philip C.; Lee, Belle; Modin, Gunnard; Benowitz, Neal L.; Wofsy, Constance B.

doi:10.1056/nejm199009203231202

Cited by 296 publications

(53 citation statements)

References 21 publications

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“…[28][29][30][31] The most frequent reactions include rash, nuetropenia, and fever. However, some evidence suggests that at least some of the adverse reactions to SMX-TMP might be due to the TMP component 19,28,31) and that sulfonamides such as SMX alone have anti-P. carinii activity.…”

Section: Discussionmentioning

confidence: 99%

Anti-fungal Activity of Sulfamethoxazole toward Aspergillus Species

Hida

Yoshida

Nakabayashi

et al. 2005

Biological & Pharmaceutical Bulletin

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Section: Discussionmentioning

confidence: 99%

Anti-fungal Activity of Sulfamethoxazole toward Aspergillus Species

Hida

Yoshida

Nakabayashi

et al. 2005

Biological & Pharmaceutical Bulletin

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“…The first well-documented cases of hyperkalemia attributable to TMP-SMX occurred in patients with AIDS treated with intravenous TMP-SMX for Pneumocystis carinii pneumonia [12]. Greenberg et al [7] noted a 1.1-mmol/l mean increase of serum potassium in AIDS patients receiving intravenous TMP-SMX for P. carinii pneumonia.…”

Section: Discussionmentioning

confidence: 99%

Trimethoprim-Induced Hyperkalemia: An Analysis of Reported Cases

Marinella¹

1999

Gerontology

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Background: Trimethoprim has been recently implicated in the development of hyperkalemia when administered at standard doses to immunocompetent patients. However, many clinicians are unaware of this potentially dangerous adverse effect. Objective: To review reported cases of trimethoprim-induced hyperkalemia in immunocompetent patients and identify predisposing factors, treatment, and outcome. Methods: A MEDLINE literature search was performed using the key words ‘trimethoprim’ and ‘hyperkalemia’. All English-language case reports and bibliographies of immunocompetent patients with trimethoprim-induced hyperkalemia were reviewed. Results: Nine cases were identified. The mean patient age was 77.6 years, and the mean duration of therapy was 10.2 days. Seven patients received standard oral dosages of trimethoprim-sulfamethoxazole for common infections, and 2 patients were concurrently receiving angiotensin-converting enzyme inhibitors. The mean pretreatment levels of creatinine and potassium were 1.01 mg/dl and 4.55 mmol/l, respectively. The mean peak serum potassium level was 7.0 mmol/l. No deaths attributable to hyperkalemia occurred. Conclusions: Hyperkalemia due to trimethoprim typically affects elderly patients administered standard oral dosages, even in the presence of a normal serum creatinine level. Concurrent angiotensin-converting enzyme inhibitor therapy may increase the risk of hyperkalemia. The prognosis is favorable with standard therapy for hyperkalemia and withdrawal of trimethoprim.

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“…Humans with acquired immune deficiency syndrome (AIDS) have a higher prevalence of hepatotoxicity associated with TMS therapy than does the general population. ", 12 The exact mechanism for this increased sensitivity is unknown. There is an increased prevalence of cutaneous eruptions from antibiotic agents in patients with Epstein-Barr virus and cytomegalovirus.'…”

mentioning

confidence: 99%

Association of Hepatic Necrosis With Trimethoprim Sulfonamide Administration in 4 Dogs

Twedt

Diehl

Lappin

et al. 1997

Veterinary Internal Medicne

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Hepatic necrosis in association with trimethoprim-sulfonamide (TMS) combination therapy was diagnosed in 4 dogs based on history, clinical presentation, and examination of histopathologic specimens collected postmortem. Duration of TMS therapy prior to onset of clinical signs ranged from 4 to 30 days. The dose of TMS ranged from 18 mg/kg to 53 mglkg bid. Despite supportive medical therapy, all dogs died or were eurimethoprim-sulfonamide (TMS) combination antibiotic T agents commonly are used in veterinary medicine to treat a variety of infectious diseases. Although adverse reactions are infrequent, polyarthritis, skin eruptions, aplastic anemia, keratoconjunctivitis sicca, fever, leukopenia, thrombocytopenia, polymyositis, and glomerulonephropathy have been reported in association with TMS therapy in dogs.'-' Hepatic necrosis has been associated with sulfonamide therapy in humans.'"-28 In addition, reversible cholestatic hepatitis has been described in people receiving TMS.'4.1"18 The purpose of this report is to describe hepatic necrosis associated with TMS therapy in 4 dogs. Clinical data for each dog are summarized in Table 1. Case ReportsDog 1. A 27-kg, I-year-old male Labrador Retriever was referred for emergency therapy of acute liver failure. There was no history of toxin exposure, the dog was current on vaccinations, and there had been no previous illnesses. Three weeks prior to referral, the dog began coughing soon after boarding in a kennel. A tentative diagnosis of tracheobronchitis was made, and therapy with trimethoprim-sulfadiazine (Tribrissen; Coopers Animal Health, Kansas City, KS), (53 m g k g PO bid) was initiated. Three days after initiation of therapy the dog became lethargic and was presented again to the referring veterinarian. During the next 24 hours, the dog became icteric and developed bilateral epistaxis and hematochezia. The dog was then referred to us for emergency care. Physical examination revealed a semicomatose patient with bilateral epistaxis, icterus, and injected mucous membranes. Given the poor prognosis, the owners elected euthanasia, and a postmortem examination was performed.Grossly, the liver was dark red with multiple yellow and pink coalescing areas. Histopathologic examination of the liver revealed marked, widespread, acute, submassive to massive periaciiiar and midzonal necrosis with resultant dilation of sinusoids, and associated congestion and hemorrhage. Mild, multifocal, lymphoplasmacytic infiltrates were found in several centriacinar regions. bile duct ectasia or accumulation of inspissated bile was noted in larger radicals A 22.6-kg, 6-month-old male Samoyed presented with lethargy and icterus. The dog had no history of previous illness until 3 weeks prior to presentation to the referring veterinarian when the dog started coughing. A tentative diagnosis of infectious tracheobronchitis was made, and the dog was treated with trimethoprimsulfamethoxazole (Bactrim; Roche Pharmaceuticals, Nutley, NJ), (21 mg/kg PO bid) for 1 week. The dog was re-evaluated because the...

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Oral Therapy forPneumocystis cariniiPneumonia in the Acquired Immunodeficiency Syndrome

Cited by 296 publications

References 21 publications

Anti-fungal Activity of Sulfamethoxazole toward Aspergillus Species

Anti-fungal Activity of Sulfamethoxazole toward Aspergillus Species

Trimethoprim-Induced Hyperkalemia: An Analysis of Reported Cases

Association of Hepatic Necrosis With Trimethoprim Sulfonamide Administration in 4 Dogs

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