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Pulmonary diseases in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Leah Lande, Abraham Sanders, Dana Zappetti
In addition to an increased rate of viral and bacterial infections of the upper and lower airway, AIDS patients with a CD4 count <200 are susceptible to infection with P. jiroveci. Limited review of pregnant patients with P. jiroveci pneumonia during pregnancy suggests that mortality is higher in this group (50%) than in nonpregnant subjects and that risk is higher in the second and third trimesters of gestation (80). However, only a small number of cases have been reported in the literature and the women reported were almost all unaware of their HIV/AIDS status at the time of pneumonia diagnosis. Therefore, they were not receiving prophylaxis against this infection. Trimethoprim–sulfamethoxazole prophylaxis should be initiated using the same guidelines as for non-pregnant women (CD4 count less than 200). Generally, pentamidine should be used during the first trimester rather than trimethoprim–sulfamethoxazole. While the fetus is most susceptible to drug teratogenicity during the first 10 weeks of gestation, if the mother’s health is poor, the benefit of therapy during this early gestational period likely outweighs the risk to the fetus (81–85). For active P. jiroveci infection at any time during pregnancy, trimethoprim–sulfamethoxazole remains the standard of care and steroid therapy should be considered in severe cases (80).
Sulfadiazine Silver
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
Nine patients allergic to sulfanilamide and one to sulfathioureum were patch tested with silver sulfadiazine 5% pet. and there were no positive reactions (7). Possible cross-sensitivity to sulfamethoxazole in a patient sensitized to sulfadiazine silver (8).
Cutaneous Adverse Drug Reactions in HIV-Infected Persons
Published in Kirsti Kauppinen, Kristiina Alanko, Matti Hannuksela, Howard Maibach, Skin Reactions to Drugs, 2020
Hélène Bocquet, Jean-Claude Roujeau
The standard treatment of cerebral toxoplasmosis by an association of pyrimethamine and sulfadiazine was shown to induce skin rashes in 7 to 75% of patients (average 28%).2,28–31 The huge variations between different studies may result from exclusion of patients with prior reaction to sulfonamides and/or from various frequency of simultaneous administration of corticosteroids in two thirds of patients in some series. A prior skin reaction to trimethoprim-sulfamethoxazole has been shown to increase the risk of adverse reaction to sulfadiazine.32 It is not known if simultaneous administration of corticosteroid for the management of intracranial hypertension decreases the incidence of rashes. While the overall rate of reactions is about the same as with trimethoprim-sulfamethoxazole, pyrimethamine-sulfadiazine is nowadays the most common cause of SJS and TEN in HIV-infected persons.
Early infectious risk in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis according to remission-induction therapy
Published in Scandinavian Journal of Rheumatology, 2023
M Gérard, H de Boysson, R Morello, N Martin-Silva, A-C Leroux, A Dumont, G Maigné, J Boutemy, K Khoy, D Mariotte, T Lobbedez, A Aouba, S Deshayes
As this was a retrospective study, the treatment was at the discretion of the physician, but national recommendations from the French Vasculitis Study Group (FVSG) were applied in clinical practice for AAV. For RIT in organ- or life-threatening AAV, tapering oral corticosteroid therapy initiated at 1 mg/kg/day, sometimes preceded by intravenous pulses of corticosteroid 500 mg to 1 g for 1–3 days in severe cases, was the rule, associated with either RTX (375 mg/m2 at D1, D7, D14, and D21, or 1 g at D1 and D14) or CYC (six 0.6 g/m2 doses at D1, D15, and D29, and then 0.7 g/m2 every 21 days). When AAV was still active after six intravenous pulses of CYC, patients frequently received three supplementary intravenous pulses at 0.7 g/m2. In most cases, patients ≥ 65 years old received a decreased dose of CYC at 500 mg, and patients with severe renal impairment received a decreased dose of CYC at 0.5 g/m2. Of note, the use of CYC historically preceded that of RTX, which progressively began in our institution at the time of inclusion in this study. Moreover, patients with severe intra-alveolar haemorrhage or severe renal impairment could receive plasma exchanges. When treated with trimethoprim–sulfamethoxazole, patients received prophylactic doses.
Therapeutic drug monitoring of intravenous busulfan in Thai children undergoing hematopoietic stem cell transplantation: A pilot study
Published in Pediatric Hematology and Oncology, 2021
Thaksin Jansing, Kleebsabai Sanpakit, Trai Tharnpanich, Thanjira Jiranantakan, Vachira Niphandwongkorn, Busba Chindavijak, Thanarat Suansanae
For seizure prophylaxis, phenytoin was administered per oral (PO) at a loading dose of 10 mg/kg and subsequently at 5 mg/kg/day divided into 2 doses, starting 12 h before the initiation of Bu until 48 h after completion of Bu. Filgrastim was administered intravenously 10 µg/kg/dose once daily, starting 24 h after the stem cell infusion (day +1) until neutrophil engraftment. GVHD prophylaxis included a short course of methotrexate (MTX) at 2 mg/kg/course divided into 4 doses, which were administered once daily on day +1, +3, +6, and +11 after stem cell infusion, and IV cyclosporine A (CSA) 3 mg/kg/day, which was divided into 2 doses every 12 h, starting 24 h before stem cell infusion. CSA level was monitored regularly to ensure maintenance at 150–250 µg/L. MTX on day +11 was omitted if the patients developed severe oral mucositis or severe infection. Ursodeoxycholic acid was administered for VOD prophylaxis at 15 mg/kg/day divided into 2 doses PO every 12 h on day +1 until day +30 post HSCT. Oral antibacterial (gentamicin or ciprofloxacin) and antifungal (fluconazole or posaconazole) prophylaxis was administered in accordance with the institutional guidelines. Trimethoprim-sulfamethoxazole 5 mg/kg/day divided into 2 doses for 3 days/week was initiated after stable engraftment and continued until the immunosuppressive drugs were terminated for 3 months.
Exploring the drug-induced anemia signals in children using electronic medical records
Published in Expert Opinion on Drug Safety, 2019
Duan-Fang Fan, Yun-Cui Yu, Xuan-sheng Ding, Xiao-Lu Nie, Ran Wei, Xin-Ying Feng, Xiao-Xia Peng, Miao-Miao Gao, Lu-Lu Jia, Xiao-Ling Wang
Finally, the remaining four associations (with sulfamethoxazole, lysine acetylsalicylate, paracetamol, and ceftriaxone) were previously known in the context of anemia. Sulfamethoxazole is indicated for the treatment of skin and urinary and respiratory tract infections caused by methicillin‐resistant Staphylococcus aureus. Treatment with sulfamethoxazole was found to aggravate the hemolysis of patients with the variants of glucose-6-phosphate dehydrogenase [32], and also caused megaloblastic anemia [33,34]. Lysine acetylsalicylate and paracetamol are non-steroidal anti-inflammatory drugs that can cause gastrointestinal bleeding and anemia [35,36]. Lysine acetylsalicylate is a complex salt of lysine and acetylsalicylate that is used for the treatment of fever and mild to moderate pain. Acetylsalicylate has been reported to cause anemia [37,38], and paracetamol may cause hemolytic anemia in patients with glucose-6-phosphate dehydrogenase deficiency [39,40]. Ceftriaxone may induce hemolytic anemia in children, which would be severe and could be fatal. Once anemia is suspected to be caused by the drug, ceftriaxone treatment should be discontinued even if the symptoms appeared to be mild. The application of the two-step method suggests that this method leads to reliable results.