Trimethoprim-Sulfamethoxazole Oral Desensitization in Hemophiliacs Infected With Human Immunodeficiency Virus With a History of Hypersensitivity Reactions

Kletzel, Morris; Beck, Suzanne A.; Elser, Joe; Shock, Nikki; Burks, Wesley

doi:10.1001/archpedi.1991.02160120096026

Cited by 8 publications

(6 citation statements)

References 11 publications

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“…Very few studies confined to children only were found. This review is limited to desensitization procedures with antibiotics, beta-lactam drugs [8, 22, 23], co-trimoxazole [12, 13, 20], ciprofloxacin [2, 9, 15], cytostatics, carboplatin [5, 14, 18, 19], l -asparaginase [21], and MMR-vaccine [16] in children only.…”

Section: Review Of the Literaturementioning

confidence: 99%

“…The starting dose for intravenous procedures is generally 1/1,000,000–1/1,000 of full therapeutic dose, but may be higher (1/100) in oral desensitization [2, 8, 9, 12, 13, 15, 20, 22, 23]. During intravenous desensitization the doses are infused continuously over 15–30 min intervals, followed by intravenous administration of the full therapeutic doses.…”

Section: Review Of the Literaturementioning

confidence: 99%

“…During intravenous desensitization the doses are infused continuously over 15–30 min intervals, followed by intravenous administration of the full therapeutic doses. In the oral procedure, dose intervals described range from 15 min (for ciprofloxacin [15]) to 12 h (for co-trimoxazole [12]). Slow or incomplete absorption from the gastrointestinal tract should be taken into account when choosing this dose interval.…”

Section: Review Of the Literaturementioning

confidence: 99%

“…In general, the symptoms could be treated by antihistamines and dose reduction or postponing dose increase [5, 12, 22, 23]. …”

Section: Review Of the Literaturementioning

confidence: 99%

“…Followed by tenfold increasesDe Maria [8]♀, 16, CFAztreonam, ceftazidimeNRPositiveIVYes♂, 10, chondritisMeropenemNRPositiveStarting dose 1/10E5 of full therapeutic dose infused in 20 min. Doubling every 20 minYesSoffritti [20]♂, 7, allogenic haematopoietic stem cell transplantation after refractory anemiaCo-trimoxazoleItching rashNegativeNR (probably oral)YesStarting dose 0.000004 mg/0.0002 mg bid, 10-fold increases up to 0.04 mg/0.2 mg, followed by dose doublingKletzel [12]♂, 7, 3 ♂, 15, 3 adults,Co-trimoxazoleRash, dyspnea, swellingNROralYes (except in one child (♂, 15) due to noncompliance)All hemophiliac, HIV+Starting dose 1/10,000 of full dose tid, followed by 1/5,000, 1/1,000, 1/500, 1/100, 1/50, 1/10. Then therapeutic dose bidKreuz [13]3 children (3–4y), HIV+Co-trimoxazoleExanthema, feverNROralYes0.2–0.4–1.6–3.2–4.8–9.2–20–40–80 mg.…”

Section: Review Of the Literaturementioning

confidence: 99%

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Clinical practice

Groot

Mulder

2010

Eur J Pediatr

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Immediate type allergic reactions to medication are potentially life threatening and can hamper drug therapy of several medical conditions. Exact incidence and prevalence data for these reactions in children are lacking. If no alternative drug treatment is available, a desensitization procedure may secure the continuation of necessary therapy. Desensitization is only appropriate in case of a strong suspicion of an IgE-mediated allergic reaction. It should be performed by trained clinicians (allergy specialists) in a hospital setting where treatment of a potential anaphylactic reaction can be done without any delay. In this article, literature describing desensitization procedures for several antibiotics, antineoplastic agents, and vaccines in children is reviewed. In general, desensitization schemes for children differ only in final dose from schemes for adults. Contradictory data were found regarding the protective effects of premedication with antihistamines and glucocorticoids.

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Section: Review Of the Literaturementioning

confidence: 99%

Section: Review Of the Literaturementioning

confidence: 99%

Section: Review Of the Literaturementioning

confidence: 99%

“…In general, the symptoms could be treated by antihistamines and dose reduction or postponing dose increase [5, 12, 22, 23]. …”

Section: Review Of the Literaturementioning

confidence: 99%

Section: Review Of the Literaturementioning

confidence: 99%

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Clinical practice

Groot

Mulder

2010

Eur J Pediatr

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A Meta-analysis of the Relative Efficacy and Toxicity of Pneumocystis carinii Prophylactic Regimens

Ioannidis

Cappelleri²,

Skolnik³

et al. 1996

Arch Intern Med

172

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Sulfamethoxazole-trimethoprim is the superior regimen, and low doses could improve tolerance without losing effectiveness for primary prophylaxis. Low doses of dapsone reduce toxic effects, but at the expense of some loss of efficacy. There are few data on the use of low-dose regimens for secondary prophylaxis. High doses of aerosolized pentamidine may improve the efficacy of this regimen. Aerosolized pentamidine is inadequate for prevention of toxoplasmosis, and strategies that improve the tolerance of oral regimens may increase effectiveness in preventing toxoplasmosis.

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Imbart-Comte

Démoly

2004

Revue Française d'Allergologie et d'Immunologie Clinique

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Trimethoprim-Sulfamethoxazole Oral Desensitization in Hemophiliacs Infected With Human Immunodeficiency Virus With a History of Hypersensitivity Reactions

Cited by 8 publications

References 11 publications

Clinical practice

Clinical practice

A Meta-analysis of the Relative Efficacy and Toxicity of Pneumocystis carinii Prophylactic Regimens

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