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[Side effects of trimethoprim-sulfamethoxazole in patients with AIDS]
T Weinke1, C Sixt, B de Matos-Marques
1II. Medizinische Klinik, Freien Universität Berlin.
Abstract:
Forty-nine episodes of Pneumocystis carinii pneumonia, treated with trimethoprim-sulfamethoxazole among 46 patients with AIDS were analysed retrospectively for any side effects. For only two were there insufficient data. There were 39 toxic reactions, 15 of them serious: leukopenia (n = 23), abnormal liver functions (n = 14), skin changes (n = 12), gastrointestinal complaints (n = 10) and thrombocytopenia (n = 9). In nine patients the treatment had to be discontinued, in six of them so early that a switch to pentamidine was necessary. Gastrointestinal symptoms occurred as early as the sixth day of treatment, while leukopenia and thrombocytopenia were first observed after 12-13 days. Despite the high rate of side effects trimethoprim-sulfamethoxazole remains the drugs of choice, other regimens not having been found to be any better.
Insights
Trimethoprim-sulfamethoxazole effectively treats Pneumocystis pneumonia in AIDS patients but causes frequent side effects like leukopenia and liver issues. Despite toxicity, it remains a preferred treatment option.
Area of Science:
- Infectious Diseases
- Pharmacology
- Immunology
Background:
- Pneumocystis carinii pneumonia (PCP) is a significant opportunistic infection in patients with Acquired Immunodeficiency Syndrome (AIDS).
- Trimethoprim-sulfamethoxazole (TMP-SMX) is a common treatment for PCP, but its adverse effects are a concern.
Purpose of the Study:
- To retrospectively analyze the side effects of trimethoprim-sulfamethoxazole treatment for Pneumocystis carinii pneumonia in patients with AIDS.
- To evaluate the frequency and severity of adverse reactions associated with TMP-SMX therapy for PCP.
Main Methods:
- Retrospective analysis of 49 episodes of PCP treated with TMP-SMX in 46 AIDS patients.
- Data collected on toxic reactions, including leukopenia, abnormal liver function, skin changes, gastrointestinal complaints, and thrombocytopenia.
Main Results:
- 39 toxic reactions were observed in 46 patients, with 15 deemed serious.
- Leukopenia (n=23), abnormal liver function (n=14), skin changes (n=12), gastrointestinal complaints (n=10), and thrombocytopenia (n=9) were the most common side effects.
- Treatment discontinuation was necessary in nine patients due to side effects, with six requiring an early switch to pentamidine.
Conclusions:
- Trimethoprim-sulfamethoxazole is associated with a high rate of side effects in AIDS patients treated for PCP.
- Despite the observed toxicities, TMP-SMX remains a drug of choice for PCP treatment in this population.
- Alternative regimens have not demonstrated superior efficacy or safety profiles compared to TMP-SMX.