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At least 577 records · Page 32Linked to original sources
PubMed1999

High rates of Pneumocystis carinii pneumonia in allogeneic blood and marrow transplant recipients receiving dapsone prophylaxis.

Chemoprophylaxis for Pneumocystis carinii pneumonia (PCP) is routinely given after allogeneic blood or marrow transplantation. We evaluated the effectiveness of dapsone prophylaxis (50 mg orally twice daily, 3 times per week) compared with twice-weekly trimethoprim-sulfamethoxazole (TMP-SMZ) in preventing PCP after allogeneic blood or marrow transplantation. Patients included all (n=646) who received allogeneic blood or marrow transplants between 1 September 1993 and 31 December 1996 who survived at least 100 days after transplantation. A cohort of 111 dapsone recipients was compared with the remaining 535 who received TMP-SMZ. Ten patients developed PCP; 8 were taking dapsone. PCP incidence in the TMP-SMZ cohort was 0.37% versus 7.2% for dapsone. The relative risk for PCP associated with dapsone use was 18.8 (P<.001) and was not accounted for by age, clinical extensive chronic graft-versus-host disease, donor source, or malignant relapse. Dapsone prophylaxis at this dosage is associated with significantly higher rates of PCP than is TMP-SMZ after allogeneic marrow transplantation. We advise caution in prescribing alternatives to TMP-SMZ prophylaxis in this setting.

Adult↗
PubMed1999

Emergence of trimethoprim-sulfamethoxazole resistance in the AIDS era.

Trimethoprim-sulfamethoxazole (TMP-SMX) is widely used for Pneumocystis carinii pneumonia prophylaxis in human immunodeficiency virus (HIV)-infected patients, but little is known about the effects of this practice on the emergence of TMP-SMX-resistant bacteria. A serial cross-sectional study of resistance to TMP-SMX among all clinical isolates of Staphylococcus aureus and 7 genera of Enterobacteriaceae was performed at San Francisco General Hospital. Resistance among all isolates was <5.5% from 1979 to 1986 but then markedly increased, reaching 20.4% in 1995. This was most prominent in HIV-infected patients: resistance increased from 6.3% in 1988 to 53% in 1995. The largest increases in resistance were in Escherichia coli (24% in 1988 to 74% in 1995) and S. aureus (0% to 48%) obtained from HIV-infected patients. A rapid increase in the use of prophylactic TMP-SMX in HIV disease was also observed during this time in San Francisco and is likely responsible for the increase in TMP-SMX resistance.

Adult↗
PubMed2001

Prophylaxis with trimethoprim-sulfamethoxazole for human immunodeficiency virus-infected patients: impact on risk for infectious diseases.

Trimethoprim-sulfamethoxazole (TMP-SMZ) is widely prescribed as prophylaxis for Pneumocystis carinii pneumonia (PCP) in human immunodeficiency virus (HIV)-infected persons. Its efficacy against other infections has not been thoroughly evaluated. To compare the risk for infectious diseases for persons who were prescribed TMP-SMZ with that for patients who were not prescribed TMP-SMZ, we examined data collected from the medical records of HIV-infected patients (January 1990 through September 1999) who were enrolled in the Adult and Adolescent Spectrum of HIV Disease Project. During intervals when patients had CD4(+) T lymphocyte counts of <200 cells/microL (19,081 persons; 22,801 person-years), prescription of TMP-SMZ was associated with significant protection from toxoplasmosis, salmonellosis, infection with Haemophilus species, invasive or any staphylococcal infection, and PCP, but not from Shigella, pneumococcal or nonpneumococcal Streptococcus, Klebsiella, or Pseudomonas species. We demonstrate that prescription of TMP-SMZ for PCP prophylaxis in persons with HIV infection is associated with significantly decreased risk for several infectious diseases. These findings may be of interest to HIV prevention programs in resource-poor countries.

AIDS-Related Opportunistic Infections↗
PubMed2004

Multidrug-resistant Escherichia coli clonal groups causing community-acquired pyelonephritis.

From October 1999 through January 2000, an Escherichia coli clonal group (designated "CgA") was isolated from the urine of nearly one-half of all women with urinary tract infections (UTIs) caused by trimethoprim-sulfamethoxazole (TMP-SMZ)-resistant E. coli in a California community. This study describes the prevalence of pyelonephritis caused by CgA in the same community. E. coli isolates were characterized by enterobacterial repetitive intergenic consensus (ERIC2) polymerase chain reaction (PCR), serogrouping, and pulsed-field gel electrophoresis. Fourteen (11%) of 130 women with UTIs received a diagnosis of pyelonephritis. CgA was associated with 4 (57%) of the 7 pyelonephritis cases caused by TMP-SMZ-resistant E. coli and was associated with none of the cases caused by TMP-SMZ-susceptible E. coli (P<.02). Six (86%) of these TMP-SMZ-resistant E. coli isolates belonged to 2 distinct ERIC2 PCR-defined clonal groups, whereas all of the TMP-SMZ-susceptible E. coli strains had unique fingerprints (P<.001). The prevalence of antimicrobial-resistant pyelonephritis in a community may be affected by a limited number of E. coli clonal groups.

Adolescent↗
PubMed1998

Clindamycin with primaquine vs. Trimethoprim-sulfamethoxazole therapy for mild and moderately severe Pneumocystis carinii pneumonia in patients with AIDS: a multicenter, double-blind, randomized trial (CTN 004). CTN-PCP Study Group.

This double-blind, randomized, multicenter trial compared clindamycin/primaquine (Cm/Prq) with trimethoprim-sulfamethoxazole (TMP-SMZ) as therapy for AIDS-related Pneumocystis carinii pneumonia (PCP). Forty-five patients received clindamycin (450 mg four times daily [q.i.d.]) and primaquine (15 mg of base/d); 42 received TMP-SMZ (320 mg/1,600 mg q.i.d. if weight of > or = 60 kg or 240 mg/1,200 mg q.i.d. if weight of < 60 kg) plus placebo primaquine. Overall, the efficacy of Cm/Prq was similar to that of TMP-SMZ (success rate, 76% vs. 79%, respectively); Cm/Prq was associated with fewer adverse events (P = .04), less steroid use (P = .18), and more rashes (P = .07). These differences were even greater for patients with PaO2 of > 70 mm Hg (P = .02, P = .04, and P = .02, respectively). For patients with PaO2 of < or = 70 mm Hg (23 Cm/Prq recipients and 21 TMP-SMZ recipients), the efficacy of Cm/Prq was similar to that of TMP-SMZ (success rate, 74% vs. 76%, respectively); Cm/Prq was associated with similar adverse events (P = .57), steroid use (P = .74), and rashes (P = .78). This trial confirms that Cm/Prq is a reasonable alternative therapy for mild and moderately severe PCP.

AIDS-Related Opportunistic Infections↗
PubMed2006

Compared with casein or total milk protein, digestion of milk soluble proteins is too rapid to sustain the anabolic postprandial amino acid requirement.

BACKGROUND: The in vivo quality of milk protein fractions has seldom been studied in humans. OBJECTIVE: Our objective was to compare the postprandial utilization of dietary nitrogen from 3 [(15)N]-labeled milk products: micellar caseins (MC), milk soluble protein isolate (MSPI), and total milk protein (TMP). DESIGN: The macronutrient intakes of 23 healthy volunteers were standardized for 1 wk, after which time the subjects ingested a meal containing MC (n = 8), MSPI (n = 7), or TMP (n = 8). [(15)N] was measured for an 8-h period in plasma amino acids, proteins, and urea and in urinary urea. RESULTS: The transfer of dietary nitrogen to urea occurred earlier after MSPI ingestion than after MC and TMP ingestion, and concentrations remained high for 8 h, concomitantly with higher but transient hyperaminoacidemia and a higher incorporation of dietary nitrogen into plasma amino acids. In contrast, deamination, postprandial hyperaminoacidemia, and the incorporation of dietary nitrogen into plasma amino acids were lower in the MC and TMP groups. Finally, total postprandial deamination values were 18.5 +/- 2.9%, 21.1 +/- 2.8%, and 28.2 +/- 2.9% of ingested nitrogen in the TMP, MC, and MSPI groups, respectively. CONCLUSIONS: Our results confirm the major role of kinetics in dietary nitrogen postprandial utilization and highlight the paradox of MSPI, which, despite its high Protein Digestibility Corrected Amino Acid Score, ensures a rate of amino acid delivery that is too rapid to sustain the anabolic requirement during the postprandial period. Milk proteins had the best nutritional quality, which suggested a synergistic effect between soluble proteins and caseins.

Adult↗
PubMed1992

Antimicrobial resistance of Shigella isolates in Bangladesh, 1983-1990: increasing frequency of strains multiply resistant to ampicillin, trimethoprim-sulfamethoxazole, and nalidixic acid.

The susceptibility to ampicillin and trimethoprim-sulfamethoxazole (TMP-SMZ) was determined for 15,824 isolates of Shigella obtained from patients attending a treatment center in Dhaka, Bangladesh, from 1983 through 1990 and for 520 isolates obtained during community surveys from 1988 through 1990. Susceptibility to nalidixic acid was determined for isolates obtained after 1985. In 1983 13% of isolates were resistant to ampicillin, 23.5% to TMP-SMZ, and 0.8% to both drugs. By 1990 51.2% of isolates obtained at the Diarrhea Treatment Centre were resistant to ampicillin, 47.7% to TMP-SMZ, and 40.5% to both drugs (for comparison with figures for 1983, P less than .001). Resistance to nalidixic acid increased from 0.8% in 1986 to 20.2% in 1990 (P less than .001). In 1990 71.5% of Shigella dysenteriae type 1 isolates were resistant to ampicillin, 68.5% to TMP-SMZ, 67.7% to both drugs, and 57.9% to nalidixic acid. The resistance pattern of isolates obtained during community surveillance was similar to that of Treatment Centre isolates. In Bangladesh ampicillin and TMP-SMZ are no longer useful for treatment of infection with any species of Shigella, and nalidixic acid is no longer useful for treatment of infections due to S. dysenteriae type 1.

Ampicillin Resistance↗
PubMed1995

Failure of treatment for chancroid in Rwanda is not related to human immunodeficiency virus infection: in vitro resistance of Haemophilus ducreyi to trimethoprim-sulfamethoxazole.

A comparative open study was performed to evaluate the efficacy of single doses of ciprofloxacin (500 mg) and trimethoprim-sulfamethoxazole (TMP-SMZ; 640 mg/3,200 mg) for the treatment of culture-proven chancroid. Clinical cure or improvement was observed 7 days after treatment in 32 (76.2%) of the 42 patients who received ciprofloxacin and 21 (52.5%) of the 40 patients who received TMP-SMZ (P = .04). Cultures for one (4.5%) of 22 patients not cured with ciprofloxacin and 16 (59.3%) of 27 patients not cured with TMP-SMZ were still positive for Haemophilus ducreyi 7 days after treatment (P < .001). Although 77 (71.3%) of the 108 patients tested were seropositive for HIV-1 antibody, HIV infection and the degree of CD4+ lymphocyte depletion had no effect on clinical and bacteriologic outcome. All isolates of H. ducreyi were highly susceptible to ciprofloxacin (MIC, 0.004-0.06 mg/L). In contrast, resistance to TMP-SMZ (MIC, > or = 4/76 micrograms/mL) was observed in 48.9% of isolates (22 of 45) and was significantly associated with treatment failure. Therefore, the administration of TMP-SMZ, in single or multiple doses, is no longer indicated for the treatment of chancroid in Rwanda.

Adult↗
PubMedDate not supplied

In vitro activity of trimethoprim and sulfamethoxazole against the nontuberculous mycobacteria.

Trimethoprim (TMP) and sulfamethoxazole (SMZ) were studied alone and in combination (TMP-SMZ) against 141 nontuberculous mycobacteria; an agar dilution method was used. All strains of Mycobacterium kansasii (8), Mycobacterium marinum (16), and Mycobacterium scrofulaceum (3); 97% (63 of 65) of strains of Mycobacterium fortuitum; and 27% (3 of 11) of strains of Mycobacterium avium-intracellulare were inhibited by less than or equal to 32 micrograms of SMZ/ml. In contrast, all 38 isolates of Mycobacterium chelonei were resistant to 32 micrograms of SMZ/ml. All species were highly resistant to TMP, with minimal inhibitory concentrations (MICs) of greater than or equal to 64 micrograms/ml. The MICs of TMP-SMZ for these organisms were similar to the MICs of SMZ alone. These results support the use of sulfonamides for treatment of infections due to M. fortuitum and M. marinum and suggest the need for further clinical and laboratory studies of the activity of these drugs against several additional mycobacterial species. TMP-SMZ appears to offer no advantage (in vitro) over SMZ alone against any of these organisms.

Agar↗
PubMedDate not supplied

Interactions of rifampin and trimethoprim in vitro.

Combination of rifampin and trimethoprim (TMP) has been suggested as a means of preventing the emergence of bacterial resistance to the individual agents and of achieving synergistic antimicrobial activity. By means of standard techniques of antimicrobial susceptibility testing, combinations of rifampin and TMP were tested against clinical isolates of a variety of aerobic bacteria. Synergism was defined as a fourfold or greater decrease in the minimal inhibitory concentration (MIC) of the more active agent in the combination. Antagonism was defined as a fourfold or greater increase in the MIC of the more active agent. No change or, at most, a twofold change was considered to represent indifference. Combinations of rifampin and TMP in ratios of 7:1, 7:2, and 1:1 demonstrated synergistic activity against 12%, 13%, and 28% of 440 isolates, respectively. Antagonism was observed in 10%, 9%, and 8% of strains tested against the above ratios. Killing curves determined with selected organisms failed to demonstrate synergistic antibacterial activity. Combinations of rifampin and TMP failed to prevent the emergence of resistance to both drugs when selected strains of various bacteria were exposed to serial, subinhibitory concentrations. Thus, synergism of rifampin and TMP was observed in only a minority of strains tested, and combination of the two agents failed to prevent the emergence of drug resistance in vitro.

Bacteria↗
PubMedDate not supplied

Combination of trimethoprim with sulfonamides other than sulfamethoxazole.

Early in the development of trimethoprim (TMP), the response to the drug was less than enthusiastic. Preliminary clinical trials were performed with sulfonamides that were unsuitable partners. On the basis of bacteriologic and pharmacokinetic evidence, sulfamethoxazole (SMZ) was chosen for the fixed-ratio (5:1) combination with TMP. Possible criteria on which to base the choice of a sulfonamide partner for TMP have been delineated. The theoretical considerations may be questioned in view of limited clinical experience with some combinations and lack of controlled comparisons in well-designed clinical trials with others. Objective proof of the clinical superiority of newer TMP-sulfonamide combinations over TMP-SMZ is required.

Bacterial Infections↗
PubMedDate not supplied

Urinary prophylaxis with trimethoprim and trimethoprim-sulfamethoxazole: efficacy, influence on the natural history of recurrent bacteriuria, and cost control.

Low-dose trimethoprim (TMP), trimethoprim-sulfamethoxazole (TMP-SMZ), and nitrofurantoin macrocrystals were found to be safe and effective as prophylaxis against recurrent urinary tract infections. Women given placebo had 2.8 infections per patient-year during the six-month study period, while women given TMP, TMP-SMZ, or nitrofurantoin had significantly lower infection rates (0.015 per patient-year). The effect of prophylaxis appeared to be limited to the period when the agents were taken. Only one patient had a TMP-resistant coliform isolated from cultures obtained during prophylaxis and six months afterwards. The sole factor associated with the recurrence of infection after prophylaxis was a history of three or more infections in the year preceding prophylaxis. Thirty-one of the 60 women in the trial were monitored for a mean of 6.1 years before and 3.2 years after they entered the study. Analysis of infection rates indicated that about half these women were experiencing an infection cluster when they entered the study and that the prestudy baseline infection rate correlated with the poststudy rate. Thus, prophylaxis did not appear to exert a long-term effect on the baseline infection rate. Urinary prophylaxis generally appears to become cost-effective when the baseline infection rate exceeds two per patient-year.

Bacteriuria↗
PubMedDate not supplied

Activity of trimethoprim-sulfamethoxazole against Chlamydia trachomatis in vitro.

With use of a technique for cell culture, the minimal inhibitory concentration (MICs) of trimethoprim (TMP) and sulfamethoxazole (SMZ), alone and in combination at ratios of 1:1, 1:5, and 1:20, were determined against five strains of Chlamydia trachomatis. The drugs were added to idoxuridine-treated McCoy cells after inoculation of the cells with the pathogen. Cultures were examined after incubation for 48 hr; the MIC was defined as the highest concentration of drugs at which no inclusions were seen. Definite end points were observed only with inocula of less than or equal to 10(3) inclusion-forming units (IFU)/ml. With larger inocula, inclusions were present for all dilutions tested. The MICs for TMP alone were greater than or equal to 64 micrograms/ml for all strains. The MICs for SMZ alone ranged from 2 to 128 micrograms/ml. There appeared to be no better than an additive effect for all combinations of TMP and SMZ tested, although the effect of 1:20 was greater than that at 1:1 or 1:5. With increasing concentrations of both drugs, the inclusions became progressively fewer, smaller, and pyknotic. Even though definite end points could not be determined, there was a significant reduction in the number of IFU/ml at relatively low concentrations of both TMP and SMZ. The results of this study suggest that the activity of TMP-SMZ against C. trachomatis is primarily that of SMZ alone.

Chlamydia trachomatis↗
PubMedDate not supplied

Trimethoprim-sulfamethoxazole in the treatment of otitis media caused by ampicillin-resistant strains of Haemophilus influenzae.

Trimethoprim-sulfamethoxazole (TMP-SMZ) was successful treatment for 93% of cases of acute otitis media caused by ampicillin-resistant Haemophilus influenzae studied. All 15 children in this study had symptoms of otitis media that were unrelieved by a course of ampicillin therapy, but 14 of them responded promptly to a 10-day course of TMP-SMZ. Potentially invasive type b strains of H. influenzae were isolated in cultures of the middle ear exudate of three children, all of whom responded well to TMP-SMZ therapy. The middle ear isolates of H. influenzae were sensitive in vitro to TMP-SMZ. It is concluded that TMP-SMZ is effective and convenient for the treatment of otitis media caused by ampicillin-resistant H. influenzae.

Ampicillin↗
PubMedDate not supplied

Use of trimethoprim-sulfamethoxazole for treatment of infections in patients with cancer.

Trimethoprim-sulfamethoxazole (TMP-SMZ) was used alone and in combination with other antimicrobial agents as treatment for infections in patients with cancer. Patients who did not respond to previous treatment with combinations of antibiotics received TMP-SMZ orally or parenterally during a total of 127 episodes of infection. The combined response rate for these two routes of administration was 49%, and the individual rates were similar for both routes. Twenty-eight infections were treated with TMP-SMZ plus tobramycin, and 75% responded after treatment with other drugs had failed. Ticarcillin plus TMP-SMZ was used as initial therapy for presumed or proved infection during 276 episodes of fever. Of 102 documented infections, 77% responded. Toxicity from TMP-SMZ was minimal.

Adult↗
PubMedDate not supplied

Trimethoprim-sulfamethoxazole in the treatment of adults with pneumonia due to Pneumocystis carinii.

The use of trimethoprim-sulfamethoxazole (TMP-SMZ) for the treatment of pneumonia due to Pneumocystis carinii has not been as rigorously assessed in studies of adults as in pediatric studies that have included patients randomly assigned to receive either pentamidine or TMP-SMZ. Nonetheless, it was shown that 80% of adults with histologically proved pneumocystis pneumonia who were treated with TMP-SMZ intravenously for at least four days or orally for at least nine days (total daily dose, 10-20 mg/kg) responded clinically and radiologically. Recipients of organ transplants and patients with lymphomas or lymphatic leukemia predominated in these studies. The median time to improvement was four days. TMP-SMZ therapy was continued for up to six days before a change to pentamidine was considered. Clinical failures of treatment were associated with delayed diagnosis and initiation of treatment, poor absorption of the orally administered drug, and concomitant life-threatening infections. Thus, a regimen involving initial intravenous therapy with doses of 15-20 mg/kg per day, with subsequent reduction of dosage or change to oral medication if improvement is rapid, was developed. With large initial intravenous doses, the monitoring of drug levels in the serum may not be necessary. Historical comparisons show that treatment of pneumocystis pneumonia with TMP-SMZ is associated with a better response rate and fewer side effects than is treatment with pentamidine.

Administration, Oral↗
PubMedDate not supplied

Use of trimethoprim-sulfamethoxazole in pediatric infections: relative merits of intravenous administration.

Trimethoprim-sulfamethoxazole (TMP-SMZ) has traditionally been employed as an oral formulation for infections in ambulatory pediatric patients. However, therapeutic concentrations of TMP and SMZ in serum and CSF are more consistently attained after intravenous administration. Serum half-life increases with the age of the child, and few significant toxic effects are observed with intravenous administration. Either the necessity to optimize bioavailability because of the underlying seriousness of disease or a desire to avoid other drugs that may be responsible for adverse reactions or hypersensitivity should direct the clinician to administer an intravenous preparation. Serious pediatric infections that might warrant the consideration of intravenous TMP-SMZ include shigellosis, salmonellosis, typhoid fever, nocardiosis, gram-negative bacillary septicemia or meningitis, and infections due to Pneumocystis carinii and malarial parasites. Infections due to Listeria will respond to TMP-SMZ, and infections due to Citrobacter diversus, Acinetobacter species, Pseudomonas cepacia, and Flavobacterium meningosepticum are especially susceptible to TMP-SMZ.

Age Factors↗
PubMedDate not supplied

Prophylaxis with trimethoprim-sulfamethoxazole in abdominal, pelvic, and prostatic surgery.

The literature on use of trimethoprim-sulfamethoxazole (TMP-SMZ) for prophylaxis in abdominal, pelvic, and prostatic surgery is meager. There is some evidence that TMP-SMZ may be effective prophylactically in biliary surgery (in patients with functioning gall bladders). Further study is needed to clarify the mixed results seen in prostatic and pelvic surgery. An evaluation was made of the effectiveness of TMP-SMZ in the prevention of endomyometritis following cesarean section in 206 women who were comparable in terms of risk factors. Among patients given a placebo, a total of 44 infections (42%) occurred, whereas among those given TMP-SMZ prophylaxis, 22 infections (22%) occurred, a statistically significant difference (P = .037, chi 2). The rate of endomyometritis among placebo recipients was 33%, as contrasted with one of 19% in those given TMP-SMZ (P = .02, chi 2). Prophylactic treatment resulted in lower rates of endomyometritis in both high- and low-risk women, but the results reached statistical significance only among high-risk patients. In essence, prophylaxis changed high-risk patients into low-risk patients.

Abdomen↗