Journal Article

A Randomized Trial of Daily and Thrice-Weekly Trimethoprim-Sulfamethoxazole for the Prevention of <i>Pneumocystis carinii</i> Pneumonia in Human Immunodeficiency Virus-Infected Persons

Wafaa M. El-Sadr, Roberta Luskin-Hawk, Teresa McCabe Yurik, Janice Walker, Donald Abrams, Stanley L. John, Renslow Sherer, Lawrence Crane, Ann Labriola, Susan Caras, Chris Pulling and Richard Hafner

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 29, issue 4, pages 775-783
Published in print August 1999 | ISSN: 1058-4838
Published online August 1999 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/520433
A Randomized Trial of Daily and Thrice-Weekly Trimethoprim-Sulfamethoxazole for the Prevention of Pneumocystis carinii Pneumonia in Human Immunodeficiency Virus-Infected Persons

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We enrolled 2,625 human immunodeficiency virus-infected patients into a randomized trial to assess the efficacy and tolerability of daily vs. thrice-weekly trimethoprim-sulfamethoxazole (160 mg/800 mg) for prophylaxis of Pneumocystis carinii pneumonia (PCP). The rate of PCP was 3.5 and 4.1 per 100 person-years in the daily and thrice-weekly groups, respectively, with a relative risk (RR) of 0.82 (95% confidence interval [CI], 0.61-1.09; P = .16) (RR of <1.0 favors daily trimethoprim-sulfamethoxazole). The RR for PCP determined by on-treatment analysis was 0.59 (P = .03). The RR for death was 0.91 (P = .12); for bacterial pneumonia, 0.82 (P = .06); and for combined PCP and bacterial pneumonia, 0.84 (P = .04). Discontinuation due to adverse events occurred more commonly in the daily trimethoprim-sulfamethoxazole group (RR, 2.14; 95% CI, 1.73-2.66; P < .001). Overall estimates for efficacy end points favored daily trimethoprim-sulfamethoxazole, although rates of intolerance were higher among patients receiving that dose. Daily trimethoprim-sulfamethoxazole may offer advantages as a first choice for PCP prophylaxis; thrice-weekly dosing is an appropriate option for patients intolerant of the daily dose.

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Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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