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Trimethoprim-sulfamethoxazole (TMP-SMZ) is the most effective Pneumocystis carinii pneumonia (PCP) prophylactic agent, but adverse reactions are common among human immunodeficiency virus (HIV)-infected patients and limit its use. This randomized, double-blind controlled trial compared 2 methods of TMP-SMZ reintroduction, 6-day dose escalation and direct rechallenge, for PCP prophylaxis in HIV-infected patients who had experienced previous treatment-limiting reactions. The primary end point was the ability to take single-strength TMP-SMZ daily for 6 months. Seventy-five percent of the dose-escalation group and 57% of the direct-rechallenge group continued to receive daily single-strength TMP-SMZ for 6 months (P= .014). Among premature discontinuations, 58% of the dose-escalation group and 70% of the direct-rechallenge group were due to adverse reactions. None of these reactions was serious. This study provides evidence that it is possible to successfully reintroduce TMP-SMZ to a significant proportion of HIV-infected patients who have experienced mild-to-moderate treatment-limiting adverse reactions.

the journal of infectious diseases (online. university of chicago press)/the journal of infectious diseases

Trimethoprim‐Sulfamethoxazole (TMP‐SMZ) Dose Escalation versus Direct Rechallenge for<i>Pneumocystis Carinii</i>Pneumonia Prophylaxis in Human Immunodeficiency Virus–Infected Patients with Previous Adverse Reaction to TMP‐SMZ

Trimethoprim‐Sulfamethoxazole (TMP‐SMZ) Dose Escalation versus Direct Rechallenge forPneumocystis CariniiPneumonia Prophylaxis in Human Immunodeficiency Virus–Infected Patients with Previous Adverse Reaction to TMP‐SMZ