First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
Antimicrob Agents Chemother. 2017 Nov 22;61(12). doi: 10.1128/AAC.01173-17. Print 2017 Dec.
The dose of trimethoprim-sulfamethoxazole (TMP-SMX) for the treatment of pneumonia (PCP) in patients without human immunodeficiency virus (HIV) infection has not been verified. The aim of this study was to investigate the efficacy and toxicity of a low-dose TMP-SMX regimen in such patients. A retrospective study was conducted in four hospitals. We reviewed the medical records of patients with PCP but not HIV (non-HIV-PCP) who were treated with TMP-SMX between 2003 and 2016. The patients were divided into conventional-dose (TMP, 15 to 20 mg/kg/day) and low-dose (TMP, <15 mg/kg/day) groups after patients who received high-dose (TMP, >20 mg/kg/day) treatment were excluded. Grouping was done according to a correction dose, which was based on renal function. Eighty-two patients had non-HIV-PCP. The numbers of patients who received high-, conventional-, and low-dose treatments were 5, 36, and 41, respectively. Kaplan-Meier analysis for death associated with PCP showed no statistically significant difference in survival rates between the conventional- and low-dose groups. Ninety-day cause-specific mortality rates were 25.0% and 19.5% in the conventional-dose and low-dose groups ( = 0.76), respectively. Adverse events that were graded as ≥3 according to the Common Terminology Criteria for Adverse Events (version 4.0) (National Cancer Institute, 2010) were 41.7% and 17.1% in the conventional-dose and low-dose groups ( = 0.02), respectively. Moreover, vomiting ( = 0.03) and a decrease in platelet count ( = 0.03) occurred more frequently in the conventional-dose group. Treatment of non-HIV-PCP with low-dose or conventional-dose TMP-SMX produces comparable survival rates; however, the low-dose regimen is better tolerated and associated with fewer adverse effects.
未证实治疗人类免疫缺陷病毒（HIV）阴性肺炎（PCP）患者的复方磺胺甲噁唑（TMP-SMX）剂量。本研究旨在调查此类患者低剂量 TMP-SMX 方案的疗效和毒性。在 4 家医院进行了一项回顾性研究。我们回顾了 2003 年至 2016 年间接受 TMP-SMX 治疗的 PCP 但非 HIV 患者（非 HIV-PCP）的病历。将接受高剂量（TMP，>20mg/kg/天）治疗的患者排除后，将患者分为常规剂量（TMP，15-20mg/kg/天）和低剂量（TMP，<15mg/kg/天）组。分组是根据肾功能进行校正剂量的。82 例患者患有非 HIV-PCP。接受高、常规和低剂量治疗的患者数量分别为 5、36 和 41。与 PCP 相关的死亡的 Kaplan-Meier 分析显示，常规剂量和低剂量组的生存率无统计学差异。常规剂量组和低剂量组的 90 天病因特异性死亡率分别为 25.0%和 19.5%（=0.76）。根据不良事件通用术语标准（第 4.0 版）（美国国家癌症研究所，2010 年）≥3 级的不良事件在常规剂量组和低剂量组中的发生率分别为 41.7%和 17.1%（=0.02）。此外，常规剂量组呕吐（=0.03）和血小板计数下降（=0.03）更为常见。用低剂量或常规剂量 TMP-SMX 治疗非 HIV-PCP 可产生相似的生存率；然而，低剂量方案更耐受且不良反应更少。
