title: Failure of sulfonamides and trimethoprim in the treatment of nocardiosis.
abstract: An immunocompromised patient with Nocardia brasiliensis pneumonia and empyema acquired disseminated disease due to Nocardia asteroides and died. The treatment of choice for pulmonary or disseminated nocardiosis is 6 to 12 g/day of sulfisoxazole (or adjusted dosage to achieve a serum level of 100 to 150 mg/L) continued for six to 18 months. Combination therapy may be beneficial in selected patients; if trimethoprim therapy is used with sulfonamides, higher than usual doses of trimethoprim may be required to achieve optimal antinocardial activity. When the condition of a patient with nocardiosis falls to improve on sulfonamide therapy, patient compliance should be questioned, serum sulfonamide levels should be measured, cultures and susceptibility studies should be repeated, and a search for sequestered pus should be made.
mesh_terms: D000328:Adult; D004359:Drug Therapy, Combination; D004653:Empyema / Q000209:etiology*; D006801:Humans; D007121:Immunocompetence; D008297:Male; D009615:Nocardia; D009617:Nocardia Infections / Q000188:drug therapy*; D009616:Nocardia asteroides; D011014:Pneumonia / Q000209:etiology*; D013449:Sulfonamides / Q000627:therapeutic use*; D014295:Trimethoprim / Q000627:therapeutic use*
chemical_list: D013449:Sulfonamides; D014295:Trimethoprim