Therapeutic failure of trimethoprim/sulfamethoxazole in the treatment of Pneumocystis carinii pneumonia.
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.
al-Tawfiq
J A
JA
Department of Medicine, School of Medicine, Indiana University, Indianapolis, USA.
Sorensen
S J
SJ
Cushing
H E
HE
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*
D000890:Anti-Infective Agents; D004338:Drug Combinations; D014295:Trimethoprim; D013420:Sulfamethoxazole