Prophylactic
trimethoprim-sulfamethoxazole (
TMP-SMZ) has been shown to reduce the incidence of
fever, parenteral
antibiotic usage, and
infections with gram-negative bacteria in hospitalized patients with
neutropenia. Furthermore,
TMP-SMZ was found to be equivalent to or better than oral, nonabsorbable
antibiotics in direct comparisons and to have an additive effect when given together with other oral, nonabsorbable
antibiotics. Adults given
TMP-SMZ continuously had fewer readmissions for
infection than did controls given
TMP-SMZ only while hospitalized.
TMP-SMZ used continuously in children with acute
leukemia was effective in preventing bacterial and
Pneumocystis carinii infections. For prophylaxis in granulocytopenic patients,
TMP appeared equivalent to
TMP-SMZ both in efficacy and incidence of side effects. However,
TMP was less effective in suppressing gastrointestinal flora, including
TMP-resistant gram-negative rods. Thus,
TMP-SMZ has some role in preventing
infections in high-risk patients, but further studies, especially comparisons with untreated patients may still be required.
TMP used alone offers little advantage and has the theoretical disadvantage of not preventing
infections caused by P. carinii or
TMP-resistant gram-negative bacteria.