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Trimethoprim-Sulfamethoxazole for the Treatment of Pneumocystis carinii Pneumonia

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Grant support: by a Research Grant from Hoffmann-LaRoche, Inc. , Nutley, New Jersey; Grants CA-23175 and CA-15688 from the National Cancer Institute; Grant HB-62971 from the National Heart, Lung, and Blood Institute; and Grant AI-15332 from the National Institute of Allergy and Infectious Diseases. Dr. Gale is a Scholar of the Leukemia Society of America.

▸Requests for reprints should be addressed to Drew J. Winston, M.D.; Division of Infectious Diseases, UCLA Center for the Health Sciences; Los Angeles, CA 90024.

Los Angeles, California

© 1980 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1980;92(6):762-769. doi:10.7326/0003-4819-92-6-762
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Intravenous trimethoprim-sulfamethoxazole therapy was evaluated in 11 consecutive patients with documented Pneumocystis carinii pneumonia and the results compared to those from previously published studies of trimethoprim-sulfamethoxazole therapy for P. carinii pneumonia. Although six patients needed mechanical ventilation, intravenous therapy was successful in seven of 11 patients (64%), and seven of nine patients (78%) receiving 4 or more days of intravenous trimethoprim-sulfamethoxazole therapy were cured. Side effects occurred in two patients (skin rash in one, nausea and vomiting in one). A review of 80 reported cases of confirmed P. carinii pneumonia initially treated with trimethoprim-sulfamethoxazole alone revealed response rates of 67.5% in all treated patients and 85.5% in patients treated for 9 or more days. The clinical response was similar in adults (63.2%) and children (68.9%). Side effects were noted in only 11 of 80 patients (13.8%). Compared to pentamidine, trimethoprim-sulfamethoxazole has a narrower toxic-therapeutic ratio and should be preferred treatment for P. carinii pneumonia in adults as well as children.


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