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- Title
Low-dose trimethoprim-sulfamethoxazole prophylaxis for toxoplasmic encephalitis in patients with AIDS.
- Authors
Carr, Andrew; Tindall, Brent; Brew, Bruce J.; Marriott, Deborah J.; Harkness, John L.; Penny, Ronald; Cooper, David A.; Carr, A; Tindall, B; Brew, B J; Marriott, D J; Harkness, J L; Penny, R; Cooper, D A
- Abstract
<bold>Objective: </bold>To determine the efficacy of low-dose trimethoprim-sulfamethoxazole (trimethoprim, 160 mg plus sulfamethoxazole, 800 mg; one tablet twice daily, 2 days per week) as primary prophylaxis against toxoplasmic encephalitis in patients with human immunodeficiency virus (HIV) infection and previous Pneumocystis carinii pneumonia.<bold>Design: </bold>A retrospective study.<bold>Setting: </bold>Tertiary referral teaching hospital.<bold>Patients: </bold>During a 3-year period after primary episodes of P. carinii pneumonia, 60 patients received trimethoprim-sulfamethoxazole, and 95 patients received pentamidine (aerosolized in 78 patients and intravenous in 17 patients) as secondary prophylaxis.<bold>Results: </bold>No patient in the trimethoprim-sulfamethoxazole group and no patient seronegative for Toxoplasma gondii developed toxoplasmic encephalitis, compared with 12 of 36 (33%; 95% Cl, 19% to 51%) seropositive patients in the pentamidine group (trimethoprim-sulfamethoxazole compared with pentamidine, P = 0.008). A significant difference was seen in the time to development of toxoplasmic encephalitis between the trimethoprim-sulfamethoxazole group (no case at 1153 days) and the pentamidine group (median time, 460 days) (P = 0.004). Neither the CD4+ lymphocyte count at the start of prophylaxis nor zidovudine therapy during the period of prophylaxis influenced the rate of toxoplasmic encephalitis in any group.<bold>Conclusions: </bold>Low-dose trimethoprim-sulfamethoxazole (four tablets per week) appears to be effective prophylaxis against toxoplasmic encephalitis in HIV-infected patients with previous P. carinii pneumonia. A prospective, randomized, controlled study is needed to further evaluate these findings.
- Subjects
TRIMETHOPRIM; CO-trimoxazole; TOXOPLASMOSIS treatment; TREATMENT of encephalitis; THERAPEUTICS
- Publication
Annals of Internal Medicine, 1992, Vol 117, Issue 2, p106
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/0003-4819-117-2-106