Low-dose intermittent trimethoprim-sulfamethoxazole for prevention of Pneumocystis carinii pneumonia in patients with human immunodeficiency virus infection

• Published in: Archives of internal medicine (1960) Vol. 151; no. 4; p. 688
• Main Authors: Wormser, G P, Horowitz, H W, Duncanson, F P, Forseter, G, Javaly, K, Alampur, S K, Gilroy, S A, Lenox, T, Rappaport, A, Nadelman, R B
• Format: Journal Article
• Language: English
• Published: United States 01.04.1991
• Subjects: Acquired Immunodeficiency Syndrome - complications; Adult; Cost-Benefit Analysis; Drug Administration Schedule; Female; HIV-1 - isolation & purification; Humans; Male; Pneumonia, Pneumocystis - complications; Pneumonia, Pneumocystis - prevention & control; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination - administration & dosage; Trimethoprim, Sulfamethoxazole Drug Combination - adverse effects; Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use
• ISSN: 0003-9926
• DOI: 10.1001/archinte.1991.00400040042010

The important role of chemoprophylaxis for the prevention of Pneumocystis carinii pneumonia (PCP) in human immunodeficiency virus type 1 (HIV)-infected patients is undisputed. The most cost-effective regimen, however, is unknown. We reviewed our experience at two hospitals in the New York City area in which low-dose, intermittent therapy with the combination of trimethoprim and sulfamethoxazole was used to prevent PCP in HIV-infected patients. During a total of 202 months of primary prophylaxis in 32 patients and 319 months of secondary prophylaxis in 35 patients, PCP was diagnosed only once. More than 80% of patients were receiving zidovudine concomitantly. Adverse reactions to trimethoprim-sulfamethoxazole occurred in 31% and 52% of those receiving primary or secondary prophylaxis, respectively. When those patients who were considered ineligible to receive trimethoprim-sulfamethoxazole prophylaxis (principally based on a prior adverse drug reaction) are also factored in, then approximately 50% of HIV-infected patients are candidates for long-term trimethoprim-sulfamethoxazole prophylaxis. The projected cost savings of this prophylaxis regimen, compared with those currently recommended by the US Public Health Service, are enormous.