Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
J Antimicrob Chemother. 2012 Nov;67(11):2749-54. doi: 10.1093/jac/dks283. Epub 2012 Jul 20.
A recent study reported that trimethoprim/sulfamethoxazole caused acute psychosis in four renal transplant patients with Pneumocystis jirovecii pneumonia. We aimed to investigate the incidence of and factors associated with trimethoprim/sulfamethoxazole-related acute psychosis in HIV-infected patients with P. jirovecii pneumonia.
We reviewed the medical records of HIV-infected patients who presented with P. jirovecii pneumonia and received trimethoprim/sulfamethoxazole at six major hospitals in Taiwan from July 2009 to May 2011. Acute psychosis was defined as the occurrence of hallucinations or delusions following the initiation of trimethoprim/sulfamethoxazole during hospitalization.
During the study period, 135 patients receiving trimethoprim/sulfamethoxazole for P. jirovecii pneumonia were enrolled and 16 (11.9%; 95% CI, 6.3%-17.4%) developed acute psychosis after a median duration of 5 days of trimethoprim/sulfamethoxazole treatment (range, 3-11 days). The incidence increased from 0% (0/16) in patients who received a daily trimethoprim dose of ≤12 mg/kg to 23.5% (4/17) in those who received a daily trimethoprim dose of >18 mg/kg. In multivariate logistic regression analysis, a higher daily dose of trimethoprim/sulfamethoxazole (OR, per 1 mg increase of trimethoprim, 1.40; 95% CI, 1.12-1.76; P = 0.0035) and use of adjunctive steroids (OR, 4.43; 95% CI, 1.14-17.15; P = 0.031) were associated with acute psychosis.
In this case series, 11.9% of HIV-infected patients developed acute psychosis while receiving trimethoprim/sulfamethoxazole for P. jirovecii pneumonia. While the study was limited by its retrospective design, the risk appeared to increase with increasing daily dose of trimethoprim/sulfamethoxazole in those vulnerable patients with multiple risks for acute psychosis.
最近的一项研究报告称，复方磺胺甲噁唑在 4 例患有肺孢子菌肺炎的肾移植患者中引起急性精神病。我们旨在研究 HIV 感染患者中，使用复方磺胺甲噁唑治疗肺孢子菌肺炎时，与药物相关的急性精神病的发生率及相关因素。
我们回顾性分析了 2009 年 7 月至 2011 年 5 月在台湾六家主要医院就诊的 HIV 感染合并肺孢子菌肺炎患者的病历资料。在住院期间，使用复方磺胺甲噁唑治疗后出现幻觉或妄想定义为急性精神病。
研究期间，共纳入 135 例接受复方磺胺甲噁唑治疗肺孢子菌肺炎的患者，其中 16 例（11.9%；95%CI：6.3%-17.4%）在使用复方磺胺甲噁唑治疗 5 天后（范围：3-11 天）出现急性精神病。接受每日磺胺甲噁唑剂量≤12mg/kg 的患者中，急性精神病发生率为 0%（0/16），而接受每日磺胺甲噁唑剂量>18mg/kg 的患者中，发生率为 23.5%（4/17）。多变量 logistic 回归分析显示，磺胺甲噁唑每日剂量较高（每增加 1mg 磺胺甲噁唑，OR 为 1.40；95%CI：1.12-1.76；P=0.0035）和使用辅助性类固醇（OR 为 4.43；95%CI：1.14-17.15；P=0.031）与急性精神病相关。
在本病例系列中，11.9%的 HIV 感染患者在接受复方磺胺甲噁唑治疗肺孢子菌肺炎时发生急性精神病。虽然该研究受到回顾性设计的限制，但对于那些存在多种急性精神病风险的易患患者，磺胺甲噁唑的日剂量增加，风险似乎增加。
