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Low-Dose Intermittent Trimethoprim-Sulfamethoxazole for Prevention of Pneumocystis carinii Pneumonia in Patients With Human Immunodeficiency Virus Infection

Gary P. Wormser, MD; Harold W. Horowitz, MD; Frederick P. Duncanson, MD; Gilda Forseter, RN; Kedarnath Javaly, MD; Sudhir K. Alampur, MD; Shelley A. Gilroy, MD; Theodore Lenox, MD; Ann Rappaport, RN, MPH; Robert B. Nadelman, MD
Arch Intern Med. 1991;151(4):688-692. doi:10.1001/archinte.1991.00400040042010.
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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 HIVinfected 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.

(Arch Intern Med. 1991;151:688-692)


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