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A dose-escalation regimen of trimethoprim–sulfamethoxazole is tolerable for prophylaxis against Pneumocystis jiroveci pneumonia in rheumatic diseases

  • Original Article
  • Published:
Modern Rheumatology

Abstract

Objective

To investigate the safety and efficacy of a dose-escalation regimen of trimethoprim–sulfamethoxazole (TMP/SMX) for prophylaxis against Pneumocystis jiroveci pneumonia (PCP) in rheumatic diseases.

Methods

Data from 41 patients, who received glucocorticoids with or without immunosuppressive agents and prophylactic use of TMP/SMX, were retrospectively analyzed. Thirteen patients were started on a daily dose of 10 % of single-strength (SS) TMP/SMX, which was increased gradually (dose-escalation group), while 28 patients were started on 1 SS tablet daily (routine group).

Results

In the dose-escalation group, the retention rate was 100 % at 6 months. In the routine group, 5 patients discontinued TMP/SMX; the retention rate was 82.1 %. Moreover, the retention rate when taking a daily dose of 50 % or more of SS TMP/SMX, or 1 SS tablet thrice-weekly, was significantly higher in the dose-escalation group (100 versus 71.4 %, P = 0.032). No PCP was observed in the dose-escalation group; however, 1 patient in the routine group, who had discontinued TMP/SMX, developed PCP. The rate of adverse effects was less, although nonsignificant, in the dose-escalation group (30.8 versus 46.4 %, P = 0.344).

Conclusions

In rheumatic diseases, a dose-escalation regimen of TMP/SMX resulted in a higher retention rate and was safer than the routine regimen.

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Acknowledgments

The authors gratefully acknowledge the support of Hiroshi Takayama, Chugai Pharmaceutical Co., Ltd., for statistical advice.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Rheumatology, Ome Municipal General Hospital, 4-16-5 Higashi-Ome, Ome, Tokyo, 198-0042, Japan

    Kenchi Takenaka, Yoji Komiya, Mineto Ota, Hayato Yamazaki & Kenji Nagasaka

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  1. Kenchi Takenaka
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  2. Yoji Komiya
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  3. Mineto Ota
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  4. Hayato Yamazaki
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  5. Kenji Nagasaka
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Correspondence to Kenji Nagasaka.

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Takenaka, K., Komiya, Y., Ota, M. et al. A dose-escalation regimen of trimethoprim–sulfamethoxazole is tolerable for prophylaxis against Pneumocystis jiroveci pneumonia in rheumatic diseases. Mod Rheumatol 23, 752–758 (2013). https://doi.org/10.1007/s10165-012-0730-x

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  • DOI: https://doi.org/10.1007/s10165-012-0730-x

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