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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).
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.
Urinary Tract Infections
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Outpatient management: either amoxicillin/clavulanic acid 625 mg 8 hourly PO for 7–10 days OR ciprofloxacin 500 mg PO 12-hourly for 7 days OR trimethoprim/sulfamethoxazole 960 mg PO 12-hourly for 14 days Note: Avoid trimethoprim/sulfamethoxazole if local resistance exceeds 20% or if this antibiotic has been administered to the patient in the previous 3 months.Add single dose of ceftriaxone 2 g IV OD or an aminoglycoside.If no signs of upper tract involvement, alternatively consider fosfomycin trometamol 3 g PO on days 1 and 3 OR pivmecillinam 200 mg PO 8-hourly for 7 days.The role of fosfomycin or pivmecillinam for pyelonephritis is unclear.
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
In our cohort, the median infection-free survival was 3 months in the RTX group, which is concordant with previous studies (26–29). This highlights the highly immunosuppressed status of AAV patients and the importance of implementing prophylactic measures as early as possible. Among these, vaccination against pneumococcal disease is recommended in AAV patients but also prior to RTX use (6, 39). As previously reported, the absence of prophylactic use of trimethoprim–sulfamethoxazole was a strong risk factor for both severe infection and infections of any severity in univariate and multivariate analyses (27). In contrast, patients treated with aerosolized pentamidine were at increased risk of infections in univariate analysis. This fact highlights the dual benefit of trimethoprim–sulfamethoxazole, which prevents both Pneumocystis and usual bacterial infections and should be associated with induction treatment in AAV patients (6, 40). Severe infections were predominantly bacterial, confirming the clear role of trimethoprim–sulfamethoxazole in the prevention of these infections.
Pharmacotherapeutic interventions for the treatment of bacterial prostatitis
Published in Expert Opinion on Pharmacotherapy, 2022
Ester Marquez-Algaba, Joaquin Burgos, Benito Almirante
In patients with CBP caused by a microorganism resistant to fluoroquinolones or in cases of intolerance to prolonged fluoroquinolone use or the presence of allergies, cotrimoxazole is a reasonable alternative. In a cost-effectiveness analysis reviewing 9 studies that included a total of 204 men with CBP treated with trimethoprim-sulfamethoxazole or fluoroquinolones, better cost-effectiveness was observed with fluoroquinolones. However, treatment with cotrimoxazole for 12 weeks yielded an initial cure rate of 68 to 100%, but with a 64% relapse rate over several years of follow-up [57]. Therefore, according to these studies and due to less-efficient tissue penetration into the prostate, trimethoprim-sulfamethoxazole is generally given for longer than six weeks. Unfortunately, there has been an increasing rate of resistance of Enterobacterales to fluoroquinolones and cotrimoxazole. In such scenarios, although data on management are very limited, potential options, according to susceptibility testing, include beta-lactams (e.g. cephalosporins) and tetracyclines (e.g. doxycycline), which are typically given for six or more weeks. In some cases, the resistance pattern may leave only intravenous agents as effective options.
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.