Are Lower Trimethoprim–Sulfamethoxazole Doses Effective for Pneumocystis Pneumonia?

Half of the currently recommended dose may be sufficient, and patients who improve rapidly can be switched to a low dose.

Current guidelines recommend treating Pneumocystis jirovecii pneumonia (PCP) with high-dose trimethoprim–sulfamethoxazole (TMP–SMX; TMP 15–20 mg/kg/day and SMX 75–100 mg/kg/day in 4 divided doses) for 2 to 3 weeks. Given the high frequency of adverse events associated with this regimen — including renal insufficiency, electrolyte disorders, and liver toxicity — researchers in the Netherlands retrospectively examined the efficacy of a TMP–SMX dose step-down strategy in 104 patients with confirmed PCP.

All patients received TMP–SMX doses lower than previously recommended. Eighty patients (77%) received standard therapy with intermediate-dose TMP–SMX (TMP 10–15 mg/kg/day and SMX 50–75 mg/kg/day) for ≥2 weeks; most patients (91%) were treated fo…

Reviewing Author

Thomas Glück, MD

Disclosures

Editorial BoardsConsilium Infectiorum by InfectoPharm, Infection

Thomas Glück, MD

Disclosures

Editorial BoardsConsilium Infectiorum by InfectoPharm, Infection

Are Lower Trimethoprim–Sulfamethoxazole Doses Effective for Pneumocystis Pneumonia?

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Reviewing Author