Trimethoprim-sulfamethoxazole dosing and outcomes of pulmonary nocardiosis.

Autor: Yetmar ZA; Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. yetmarz@ccf.org.; Department of Infectious Disease, Cleveland Clinic Foundation, Cleveland, OH, USA. yetmarz@ccf.org., Khodadadi RB; Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA., Chesdachai S; Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA., McHugh JW; Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA., Clement J; Department of Pharmacy, Mayo Clinic, Rochester, MN, USA., Challener DW; Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA., Wengenack NL; Division of Clinical Microbiology, Mayo Clinic, Rochester, MN, USA., Bosch W; Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL, USA., Seville MT; Division of Infectious Diseases, Mayo Clinic, Phoenix, Arizona, USA., Beam E; Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Jazyk: angličtina
Zdroj: Infection [Infection] 2024 Jun 26. Date of Electronic Publication: 2024 Jun 26.
DOI: 10.1007/s15010-024-02323-9
Abstrakt: Background: Nocardia often causes pulmonary infection among those with chronic pulmonary disease or immunocompromising conditions. Trimethoprim-sulfamethoxazole (TMP-SMX) is recommended as first-line treatment, though little data exists regarding outcomes of different dosing regimens.
Methods: We performed a multicenter retrospective cohort study of adult patients with non-disseminated pulmonary nocardiosis initially treated with TMP-SMX monotherapy. Patients' initial TMP-SMX dosing was categorized as high- (> 10 mg/kg/day), intermediate- (5-10 mg/kg/day) or low-dose (< 5 mg/kg/day). Outcomes included one-year mortality, post-treatment recurrence, and dose adjustment or early discontinuation of TMP-SMX. SMX serum concentrations and their effect on management were also assessed. Inverse probability of treatment weighting was applied to Cox regression analyses.
Results: Ninety-one patients were included with 24 (26.4%), 37 (40.7%), and 30 (33.0%) treated with high-, intermediate-, and low-dose TMP-SMX, respectively. Patients who initially received low-dose (HR 0.07, 95% CI 0.01-0.68) and intermediate-dose TMP-SMX (HR 0.27, 95% CI 0.07-1.04) had lower risk of one-year mortality than the high-dose group. Risk of recurrence was similar between groups. Nineteen patients had peak SMX serum concentrations measured which resulted in 7 (36.8%) dose changes and was not associated with one-year mortality or recurrence. However, 66.7% of the high-dose group required TMP-SMX dose adjustment/discontinuation compared to 24.3% of the intermediate-dose and 26.7% of the low-dose groups (p = 0.001).
Conclusions: Low- and intermediate-dose TMP-SMX for non-disseminated pulmonary nocardiosis were not associated with poor outcomes compared to high-dose therapy, which had a higher rate of dose adjustment/early discontinuation. Historically used high-dose TMP-SMX may not be necessary for management of isolated pulmonary nocardiosis.
(© 2024. The Author(s).)
Databáze: MEDLINE
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