title: A randomized trial of daily and thrice-weekly trimethoprim-sulfamethoxazole for the prevention of Pneumocystis carinii pneumonia in human immunodeficiency virus-infected persons. Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA)
abstract: We enrolled 2,625 human immunodeficiency virus-infected patients into a randomized trial to assess the efficacy and tolerability of daily vs. thrice-weekly trimethoprim-sulfamethoxazole (160 mg/800 mg) for prophylaxis of Pneumocystis carinii pneumonia (PCP). The rate of PCP was 3.5 and 4.1 per 100 person-years in the daily and thrice-weekly groups, respectively, with a relative risk (RR) of 0.82 (95% confidence interval [CI], 0.61-1.09; P = .16) (RR of <1.0 favors daily trimethoprim-sulfamethoxazole). The RR for PCP determined by on-treatment analysis was 0.59 (P = .03). The RR for death was 0.91 (P = .12); for bacterial pneumonia, 0.82 (P = .06); and for combined PCP and bacterial pneumonia, 0.84 (P = .04). Discontinuation due to adverse events occurred more commonly in the daily trimethoprim-sulfamethoxazole group (RR, 2.14; 95% CI, 1.73-2.66; P < .001). Overall estimates for efficacy end points favored daily trimethoprim-sulfamethoxazole, although rates of intolerance were higher among patients receiving that dose. Daily trimethoprim-sulfamethoxazole may offer advantages as a first choice for PCP prophylaxis; thrice-weekly dosing is an appropriate option for patients intolerant of the daily dose.
authors.affiliation: Harlem Hospital Center and Columbia University, College of Physicians and Surgeons, New York, New York 10037, USA. wme1@columbia.edu
authors.forename: W M
authors.initials: WM
authors.lastname: El-Sadr
authors.forename: R
authors.initials: R
authors.lastname: Luskin-Hawk
authors.forename: T M
authors.initials: TM
authors.lastname: Yurik
authors.forename: J
authors.initials: J
authors.lastname: Walker
authors.forename: D
authors.initials: D
authors.lastname: Abrams
authors.forename: S L
authors.initials: SL
authors.lastname: John
authors.forename: R
authors.initials: R
authors.lastname: Sherer
authors.forename: L
authors.initials: L
authors.lastname: Crane
authors.forename: A
authors.initials: A
authors.lastname: Labriola
authors.forename: S
authors.initials: S
authors.lastname: Caras
authors.forename: C
authors.initials: C
authors.lastname: Pulling
authors.forename: R
authors.initials: R
authors.lastname: Hafner
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control*; D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000517:prevention & control; D011020:Pneumonia, Pneumocystis / Q000517:prevention & control*; D011446:Prospective Studies; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination