A retrospective case-notes audit of 359 HIV-1-infected adult patients with first-episode laboratory-confirmed Pneumocystis jirovecii pneumonia treated with co-trimoxazole (from 1987 adjuvant steroids were used if PaO2 <9.3 kPa) showed that only 230/359 (64%) patients completed treatment; 104 (29%) patients had treatment-limiting toxicity; rash occurred in 4/60 (6.7%) patients in 1985–1988 and in 15/47 (31.9%) in 2005–2008. Twenty-five patients (7%) failed co-trimoxazole treatment. Overall mortality was 13.6% (49/359); mortality among patients who failed co-trimoxazole treatment was 48% (12/25) and by contrast mortality was 4.8% (5/104) among patients with treatment-limiting toxicity.
WhartonJM, ColemanDL, WofsyCB, Trimethoprim-sulfamethoxazole or pentamidine for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. A prospective randomized trial. Ann Intern Med1986;105:37–44
2.
SattlerFR, CowanR, NielsenDM, RuskinJ. Trimethoprim-sulfamethoxazole compared with pentamidine for treatment of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome: a prospective, noncrossover study. Ann Intern Med1988;109:280–7
3.
KleinNC, DuncansonFP, LenoxTH, Trimethoprim-sulfamethoxazole versus pentamidine for Pneumocystis carinii pneumonia in AIDS patients: results of a large prospective randomized treatment trial. AIDS1992;6:301–5
4.
JaffeHS, AbramsDI, AmmannAJ, LewisBJ, GoldenJA. Complications of co-trimoxazole in treatment of AIDS-associated Pneumocystis carinii pneumonia in homosexual men. Lancet1983;2:1109–11
5.
HughesWT, LafonSW, ScottJD, MasurH. Adverse events associated with trimethoprim-sulfamethoxazole and atovaquone during the treatment of AIDS-related Pneumocystis carinii pneumonia. J Infect Dis1995;171:1295–301
6.
GordinFM, SimonGL, WofsyCB, MillsJ. Adverse reactions to trimethoprim-sulfamethoxazole in patients with the acquired immunodeficiency syndrome. Ann Intern Med1984;100:495–9
WalzerPD, EvansHER, CopasAJ, EdwardsSG, GrantAD, MillerRF. Early predictors of mortality from Pneumocystis jirovecii pneumonia in HIV-infected patients: 1985–2006. Clin Infect Dis2008;46:625–33
9.
GillHJ, MaggsJL, MaddenS, PirmohamedM, ParkBK. Co-administration of fluconazole (but not ketoconazole) to healthy volunteers inhibits oxidation of sulphamethoxazole to the hydroxylamine metabolite. Br J Clin Pharmacol1996;42:347–53
10.
National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and the HIV Medicine Association of the Infectious Diseases Society of America (HIVMA/IDSA). Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents (2008). http://aidsinfo.nih.gov/contentfiles/Adult_OI.pdf (last accessed 18 November 2008)
