Failure of Trimethoprim/Sulfamethoxazole Prophylaxis for Pneumocystis carinii Pneumonia with Concurrent Leucovorin Use

  title={Failure of Trimethoprim/Sulfamethoxazole Prophylaxis for Pneumocystis carinii Pneumonia with Concurrent Leucovorin Use},
  author={By Razavi and Benedicte Lund and Bradley L. Allen and Larry S. Schlesinger},
Pneumocystis carinii is a common cause of pneumonia in patients with AIDS, however, the incidence has dropped with the availability of effective prophylactic regimens. First-line treatment for both acute Pneumocystis pneumonia and chronic prophylaxis is trimethoprim/sulfamethoxazole (TMP/SMX). This combination can cause hypersensitivity reactions as well as myelosuppression. The simultaneous administration of leucovorin during acute treatment has bee shown to reduce the incidence of neutropenia… 
Twice Weekly Pneumocystis jiroveci Pneumonia Prophylaxis With Trimethoprim-Sulfamethoxazole in Pediatric Patients With Acute Lymphoblastic Leukemia
Twice weekly TMP/SMX seems to be a reasonable alternative for PCP prophylaxis for pediatric ALL patients and can likely be extended to other pediatric malignancies as well.
Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and with HIV
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  • 2020
The taxonomy of the organism has been changed; Pneumocystis carinii now refers only to the P pneumonia that infects rats, and P. jirovecii refers to the distinct species that infecting humans.
Prevention of Infection Due to Pneumocystis spp. in Human Immunodeficiency Virus-Negative Immunocompromised Patients
The risk for PCP varies based on individual immune defects, regional differences, and immunosuppressive regimens, and the agent of choice for prophylaxis against Pneumocystis unless a clear contraindication is identified.
Less common bacterial, fungal and viral infections: review of management in the pregnant patient
This review is a comprehensive summary of treatment options for pregnant patients with less common bacterial, fungal, and viral infections. It offers guidance to clinicians based on the most recently
Levoleucovorin as Replacement for Leucovorin in Cancer Treatment
The results of the clinical studies suggest that levoleucovorin is efficacious and can be used safely in combination with fluorouracil and other antitumor agents, and leucavorin remains the drug of choice.
Antimicrobial Dihydrofolate Reductase Inhibitors - Achievements and Future Options: Review
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There are excellent chances for new drugs in this field, and they are thought to increase by limiting the spectrum of activity, whereas trimethoprim seems to present the optimum which can be achieved for a broad spectrum antibacterial agent.
Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America.
This report updates and combines earlier versions of guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents and adds malaria to the list of OIs that might be acquired during international travel.


Comparative trial of dapsone versus trimethoprim/sulfamethoxazole for primary prophylaxis of Pneumocystis carinii pneumonia.
Both dapsone and trimethoprim/sulfamethoxazole are efficacious for the prophylaxis of PCP in HIV-infected persons with less than 200 CD4-positive cells per ml, but are each associated with significant toxicity.
Pneumocystis carinii mutations associated with sulfa and sulfone prophylaxis failures in AIDS patients
Results were consistent with the possibility that mutations in the P. carinii dihydropteroate synthase (DHPS) are responsible for some of the failures of sulfa/sulfone prophylaxis in AIDS patients.
Adjunctive folinic acid with trimethoprim-sulfamethoxazole for Pneumocystis carinii pneumonia in AIDS patients is associated with an increased risk of therapeutic failure and death.
Folinic acid use was associated with a higher rate of both therapeutic failure and death and time to therapeutic failure was shorter and probability of death greater in patients receiving folinic acid, even when adjusted for baseline arterial oxygen pressure, serum lactate dehydrogenase, respiratory rate, CD4 cell count, and peak serum level of trimethoprim or sulfamethoxazole.
Preventing Pneumocystis carinii pneumonia in persons infected with human immunodeficiency virus.
The incidence of PCP can be reduced substantially if persons at risk for PCP are identified and receive adequate chemoprophylaxis, and several drugs and drug combinations are highly effective in preventing PCP.
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