title: Therapeutic failure of trimethoprim/sulfamethoxazole in the treatment of Pneumocystis carinii pneumonia.
abstract: OBJECTIVE
  To report a case of failure of treatment of Pneumocystis carinii pneumonia (PCP) with trimethoprim/sulfamethoxazole (TMP/SMX) in a patient with HIV infection, despite an adequate serum SMX concentration.
  
  
  METHODS
  A 52-year-old white man was treated with TMP/SMX for PCP. After discharge he returned to the hospital with worsening of the PCP despite a serum SMX concentration of 60 micrograms/mL 18 hours after his last dose of TMP/SMX.
  
  
  CONCLUSIONS
  PCP is one of the most common complications of HIV infection. TMP/SMX is the drug of choice for prophylaxis and treatment. The causes of therapeutic failure with this agent are not well documented.
  
  
  CONCLUSIONS
  Alternative therapies to TMP/SMX should be seriously considered if the serum concentrations are therapeutic and the patient is not clinically improved.
authors.affiliation: Department of Medicine, School of Medicine, Indiana University, Indianapolis, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: al-Tawfiq
authors.forename: S J
authors.initials: SJ
authors.lastname: Sorensen
authors.forename: H E
authors.initials: HE
authors.lastname: Cushing
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy*; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D004338:Drug Combinations; D006801:Humans; D008297:Male; D008875:Middle Aged; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy*; D013420:Sulfamethoxazole / Q000097:blood / Q000627:therapeutic use*; D017211:Treatment Failure; D014295:Trimethoprim / Q000097:blood / Q000627:therapeutic use*
chemical_list: D000890:Anti-Infective Agents; D004338:Drug Combinations; D014295:Trimethoprim; D013420:Sulfamethoxazole