Low- versus high-dose trimethoprim-sulfamethoxazole for the treatment of pneumonia.

OBJECTIVE

To compare outcomes of patients treated with low-dose (LD) versus high-dose (HD) trimethoprim-sulfamethoxazole (TMP-SMX) for pneumonia.

DESIGN

Retrospective cohort study.

SETTING

Large academic tertiary-care center.

PATIENTS

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

No differences in clinical success or adverse events were observed in patients with pneumonia treated with either LD or HD TMP-SMX.