Adverse reactions to trimethoprim-sulfamethoxazole.

Abstract

TMP-SMX is the drug of choice for the treatment and prophylaxis of Pneumocystis carinii pneumonia (PCP) in patients with the acquired immunodeficiency syndrome (AIDS). However, the therapeutic benefit of this drug combination is often limited by a high incidence of serious adverse reactions. An increased frequency of adverse reactions to TMP-SMX in HIV-infected patients has been noted (1–5). Kovacs et al. (1) reported that 22 (65%) of 34 patients with AIDS developed adverse reactions while being treated with TMP-SMX, but only 2 (12%) of 17 patients without AIDS who were similarly treated had adverse responses. Jaffe et al. (2) noted that 8 (44%) of 18 patients treated with iv TMP-SMX developed fever, rash, and cytopenias; four patients were rechallenged, and all experienced a recurrence of their rashes. Gordin et al. (3) found that 83% of patients with AIDS developed one or more adverse reactions, and that in 65% of them, TMP-SMX had to be discontinued. Mitsuyasu et al. (4) reported cutaneous eruptions in 16 (64%) of 25 patients treated with TMP-SMX, including 8 of the 10 patients who received it only for prophylaxis. Medina et al. (5) found that 17 (57%) of 30 patients with AIDS developed major adverse reactions to TMP-SMX, and 29 (95%) of 30 patients developed minor adverse reactions.