Taranto Bradley, Wardlow Lynn C, Coe Kelci, Bazan Jose A, Leininger Jessica
Department of Pharmacy, Mount Carmel East Hospital, Columbus, OH, USA.
Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Antimicrob Steward Healthc Epidemiol. 2025 Apr 15;5(1):e95. doi: 10.1017/ash.2025.64. eCollection 2025.
To compare outcomes of patients treated with low-dose (LD) versus high-dose (HD) trimethoprim-sulfamethoxazole (TMP-SMX) for pneumonia.
Retrospective cohort study.
Large academic tertiary-care center.
Hospitalized adult patients who received at least 8 mg/kg/day of TMP-SMX for at least 96 hours for treatment of pneumonia between October 2012 and September 2022. Patients were included if they were diagnosed with pneumonia based on clinical and radiographic findings at the time of initiation of antibiotics.
The primary outcome was clinical success at the end of therapy among patients treated with LD (8-12 mg/kg/day) versus HD (>12 mg/kg/day) TMP-SMX. Secondary outcomes included microbiological success, all-cause and infection-related inpatient mortality, infection recurrence, development of TMP-SMX resistance, and incidence of acute kidney injury (AKI) and hyperkalemia.
95 patients were included (LD, = 20 versus HD, = 75). There was no difference in the primary outcome of clinical success at the end of therapy between groups (LD 57% versus HD 65%, = 0.53). Secondary outcomes, including inpatient infection-related mortality ( = 0.56), AKI ( = 0.61), and hyperkalemia ( = 0.34) also did not differ significantly between the LD and HD groups.
No differences in clinical success or adverse events were observed in patients with pneumonia treated with either LD or HD TMP-SMX.
比较低剂量（LD）与高剂量（HD）甲氧苄啶-磺胺甲恶唑（TMP-SMX）治疗肺炎患者的疗效。
回顾性队列研究。
大型学术三级医疗中心。
2012年10月至2022年9月期间因肺炎接受至少96小时、至少8mg/kg/天TMP-SMX治疗的住院成年患者。如果患者在开始使用抗生素时根据临床和影像学检查结果被诊断为肺炎，则纳入研究。
主要结局是接受LD（8-12mg/kg/天）与HD（>12mg/kg/天）TMP-SMX治疗的患者在治疗结束时的临床成功率。次要结局包括微生物学成功率、全因和感染相关的住院死亡率、感染复发、TMP-SMX耐药性的发生以及急性肾损伤（AKI）和高钾血症的发生率。
纳入95例患者（LD组20例，HD组75例）。两组之间治疗结束时临床成功的主要结局无差异（LD组57%，HD组65%，P=0.53）。次要结局，包括住院感染相关死亡率（P=0.56）、AKI（P=0.61）和高钾血症（P=0.34）在LD组和HD组之间也无显著差异。
LD或HD TMP-SMX治疗肺炎患者的临床成功率或不良事件无差异。
