title: Low-dose intermittent trimethoprim-sulfamethoxazole for prevention of Pneumocystis carinii pneumonia in patients with human immunodeficiency virus infection.
abstract: 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.
authors.affiliation: Department of Medicine, Westchester County Medical Center.
authors.forename: G P
authors.initials: GP
authors.lastname: Wormser
authors.forename: H W
authors.initials: HW
authors.lastname: Horowitz
authors.forename: F P
authors.initials: FP
authors.lastname: Duncanson
authors.forename: G
authors.initials: G
authors.lastname: Forseter
authors.forename: K
authors.initials: K
authors.lastname: Javaly
authors.forename: S K
authors.initials: SK
authors.lastname: Alampur
authors.forename: S A
authors.initials: SA
authors.lastname: Gilroy
authors.forename: T
authors.initials: T
authors.lastname: Lenox
authors.forename: A
authors.initials: A
authors.lastname: Rappaport
authors.forename: R B
authors.initials: RB
authors.lastname: Nadelman
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D005260:Female; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D011020:Pneumonia, Pneumocystis / Q000150:complications / Q000517:prevention & control*; D013997:Time Factors; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D015662:Trimethoprim, Sulfamethoxazole Drug Combination