TMP-SMX Prophylaxis: Don't Let Concern for Antimicrobial Resistance Stop You

Trimethoprim-sulfamethoxazole (known as TMP-SMX or cotrimoxazole) is recommended for prevention of opportunistic infections in HIV-infected adults and in infants born to HIV-infected women. However, widespread use of this drug as prophylaxis remains limited, particularly in resource-constrained settings where shortages of trained staff, stock-outs, failure to identify those who would benefit, and fears of antimicrobial resistance have hindered implementation.

Now, a systematic review has shown that TMP-SMX prophylaxis might actually protect HIV-infected patients against resistance to other antibiotics. The review included 17 qualifying studies, 8 of which were considered high quality. Most of the studies did not provide data on duration of e…