Comparison of high and low doses of trimethoprim-sulfamethoxazole for primary prevention of toxoplasmic encephalitis in human immunodeficiency virus-infected patients.

Abstract

To evaluate the influence of the dose of co-trimoxazole prophylaxis on the risk of toxoplasmosis in human immunodeficiency virus (HIV)-infected patients, we performed a nested case-control study of 32 patients with toxoplasmosis (case patients) and 64 patients without toxoplasmosis (control patients) who were matched by CD4 cell count and Toxoplasma gondii serostatus; these patients were from a cohort of 521 HIV-infected patients who underwent a diagnostic neuroimaging study between March 1993 and January 1997. Twenty-seven (84.4%) of 32 case patients and 33 (51.6%) of 64 control patients received low doses of co-trimoxazole, a finding associated with an adjusted odds ratio (OR) of 9.36 (95% confidence interval [CI], 2.05-42.75) and indicating 89% protective efficacy for high doses. Fifteen (46.9%) of 32 case patients and 16 (25%) of 64 control patients were exposed to rifampin (adjusted OR, 3.38; 95% CI, 1.08-10.61). These results indicate that high doses of co-trimoxazole appear to be more effective than low doses for lowering the risk of toxoplasmosis in HIV-infected patients and that rifampin therapy may reduce the efficacy of co-trimoxazole.

• Authors: E Ribera, A Fernandez-Sola, C Juste, A Rovira, F J Romero, L Armadans-Gil, I Ruiz, I Ocaña, A Pahissa
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 29 Issue 6 Pg. 1461-6 (Dec 1999) ISSN: 1058-4838 [Print] United States
• PMID: 10585796 (Publication Type: Clinical Trial, Comparative Study, Controlled Clinical Trial, Journal Article)

Chemical References

• Anti-Infective Agents
• Antibiotics, Antitubercular
• Trimethoprim, Sulfamethoxazole Drug Combination
• Rifampin

Topics

• AIDS-Related Opportunistic Infections (prevention & control)
• Adult
• Animals
• Anti-Infective Agents (administration & dosage, therapeutic use)
• Antibiotics, Antitubercular (therapeutic use)
• Case-Control Studies
• Dose-Response Relationship, Drug
• Drug Therapy, Combination
• Encephalitis (complications, parasitology, prevention & control)
• Female
• HIV Infections (complications, drug therapy)
• Humans
• Male
• Rifampin (therapeutic use)
• Toxoplasma (drug effects)
• Toxoplasmosis, Cerebral (complications, prevention & control)
• Treatment Outcome
• Trimethoprim, Sulfamethoxazole Drug Combination (administration & dosage, therapeutic use)