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- Title
Does Trimethoprim-Sulfamethoxazole Prophylaxis for HIV Induce Bacterial Resistance to Other Antibiotic Classes?: Results of a Systematic Review.
- Authors
Sibanda, Euphemia L.; Weller, Ian V.D.; Hakim, James G.; Cowan, Frances M.
- Abstract
A systematic review designed to explore whether cotrimoxazole prophylaxis for HIV increases bacterial resistance to other classes of antibiotics. There is suggestive evidence that cotrimoxazole protects against antibiotic resistance.Background. Trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis has long been recommended for immunosuppressed HIV-infected adults and children born to HIV-infected women. Despite this, many resource-limited countries have not implemented this recommendation, partly because of fear of widespread antimicrobial resistance not only to TMP-SMX, but also to other antibiotics. We aimed to determine whether TMP-SMX prophylaxis in HIV-infected and/or exposed individuals increases bacterial resistance to antibiotics other than TMP-SMX.Methods. A literature search was conducted in Medline, Global Health, Embase, Web of Science, ELDIS, and ID21.Results. A total of 501 studies were identified, and 17 met the inclusion criteria. Only 8 studies were of high quality, of which only 2 had been specifically designed to answer this question. Studies were classified as (1) studies in which all participants were infected and/or colonized and in which rates of bacterial resistance were compared between those taking or not taking TMP-SMX and (2) studies comparing those who had a resistant infection with those who were not infected. Type 1 studies showed weak evidence that TMP-SMX protects against resistance. Type 2 studies provided more convincing evidence that TMP-SMX protects against infection.Conclusion. There was some evidence that TMP-SMX prophylaxis protects against resistance to other antibiotics. However, more carefully designed studies are needed to answer the question conclusively.
- Subjects
CO-trimoxazole; DRUG resistance in microorganisms; ANTIBIOTICS; SYSTEMATIC reviews; QUESTIONS &; answers; IMMUNOSUPPRESSION
- Publication
Clinical Infectious Diseases, 2011, Vol 52, Issue 9, p1184
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/cir067