Department of Rheumatology, Ome Municipal General Hospital, 4-16-5 Higashi-Ome, Ome, Tokyo 198-0042, Japan.
Mod Rheumatol. 2013 Jul;23(4):752-8. doi: 10.1007/s10165-012-0730-x. Epub 2012 Aug 22.
To investigate the safety and efficacy of a dose-escalation regimen of trimethoprim-sulfamethoxazole (TMP/SMX) for prophylaxis against Pneumocystis jiroveci pneumonia (PCP) in rheumatic diseases.
Data from 41 patients, who received glucocorticoids with or without immunosuppressive agents and prophylactic use of TMP/SMX, were retrospectively analyzed. Thirteen patients were started on a daily dose of 10% of single-strength (SS) TMP/SMX, which was increased gradually (dose-escalation group), while 28 patients were started on 1 SS tablet daily (routine group).
In the dose-escalation group, the retention rate was 100% at 6 months. In the routine group, 5 patients discontinued TMP/SMX; the retention rate was 82.1%. Moreover, the retention rate when taking a daily dose of 50% or more of SS TMP/SMX, or 1 SS tablet thrice-weekly, was significantly higher in the dose-escalation group (100 versus 71.4%, P = 0.032). No PCP was observed in the dose-escalation group; however, 1 patient in the routine group, who had discontinued TMP/SMX, developed PCP. The rate of adverse effects was less, although nonsignificant, in the dose-escalation group (30.8 versus 46.4%, P = 0.344).
In rheumatic diseases, a dose-escalation regimen of TMP/SMX resulted in a higher retention rate and was safer than the routine regimen.
研究氨苯砜-磺胺甲噁唑（TMP/SMX）剂量递增方案预防风湿性疾病中卡氏肺孢子虫肺炎（PCP）的安全性和有效性。
回顾性分析了 41 例接受糖皮质激素和/或免疫抑制剂治疗并预防性使用 TMP/SMX 的患者数据。13 例患者开始使用 10%单倍强度（SS）TMP/SMX 的日剂量，逐渐递增（剂量递增组），而 28 例患者开始每天服用 1 片 SS（常规组）。
在剂量递增组，6 个月时的保留率为 100%。在常规组中，有 5 例患者停止服用 TMP/SMX，保留率为 82.1%。此外，剂量递增组服用 50%或更多 SS TMP/SMX 日剂量或每周 3 次服用 1 片 SS 时的保留率明显更高（100%比 71.4%，P=0.032）。剂量递增组未观察到 PCP；然而，常规组中有 1 例患者停止服用 TMP/SMX 后发生了 PCP。虽然差异无统计学意义，但剂量递增组的不良反应发生率较低（30.8%比 46.4%，P=0.344）。
在风湿性疾病中，TMP/SMX 剂量递增方案比常规方案具有更高的保留率和安全性。
