CHRISTOPHER STOCK, B.A.
To the editor: In a recent letter Kinzie and Taylor (1) discuss their rationale for recommending the prophylactic use of folinic acid for patients receiving high doses of trimethoprim-sulfamethoxazole. Although there are legitimate concerns about hematologic toxicity from high doses of trimethoprim-sulfamethoxazole, I have reservations about the routine use of folinic acid. To date there are no well-designed studies with trimethoprim-sulfamethoxazole or other antifolates that compare treatment outcomes when using or omitting folinic acid.
The inference that Pneumocystis carinii, the frequent target of high-dose trimethoprim-sulfamethoxazole, cannot utilize exogenous folinic acid is probably correct as it is generally thought that protozoa
STOCK C. Trimethoprim-Sulfamethoxazole and Folinic Acid. Ann Intern Med. ;102:277. doi: 10.7326/0003-4819-102-2-277_1
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Published: Ann Intern Med. 1985;102(2):277.
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