Trimethoprim-sulfamethoxazole failure

Randomized trials show trimetrexate is less effective than trimethoprim-sulfamethoxazole (failure rates 40% and 24%, respectively)... 

Antibiotic resistance plays a smaller role in pharyngitis therapy compared with other URIs. O Penicillin resistance has not yet been documented in group A streptococci, but resistance and clinical failures occur more frequently with tetracyclines, trimethoprim-sulfamethoxazole, and to a lesser degree macrolides. 

The recommended treatment is doxycycline (200 mg/day) plus rifampin (600 mg/day) for six weeks. An alternative effective treatment is six weeks of doxycycline (200 mg/day) plus streptomycin (1 gm/day) for three weeks. Trimethoprim-sulfamethoxazole given four to six weeks is less effective. In 5 to f 0 percent of cases, there may be a relapse or treatment failure. Regarding prophylaxis, killed and live attenuated human vaccines are available in many countries but are considered of unproven efficacy. There tends to be no information on the use of antibiotics for prophylaxis against human brucellosis. 

Safrin S, Lee BL, Sande MA. Adjunctive fohnic acid with trimethoprim-sulfamethoxazole for Pneumocystis carinii pneumonia in AIDS patients is associated with an increased risk of therapeutic failure and death. I Infect Dis 1994 170(4) 912-17. 

Tse W, Singer C, Dominick D. Acute fulminant hepatic failure caused by trimethoprim-sulfamethoxazole. Infect Dis Clin Pract 2000 9 302-3. 

Ilario MJ, Ruiz JE, Axiotis CA. Acute fulminant hepatic failure in a woman treated with phenytoin and trimethoprim-sulfamethoxazole. Arch Pathol Lab Med 2000 124(12) 1800-3. 

For treatment of HIV-associated PCP, pentamidine isethionate is administered intravenously usually in doses of 4 mg/kg per day, although a pilot study has reported successful treatment with 3 mg/kg per day. Aerosolized pentamidine should not be used for treatment of PCP because comparative studies with intravenous pentamidine indicate that aerosolized treatment is associated with a slower clinical response and higher rates of therapeutic failure and PCP relapse. The efficacy of trimethoprim-sulfamethoxazole or pentamidine for treatment of an initial episode of PCP in HIV-infected individuals is similar, with published response rates between 60% to 80%. While comparative studies between the two regimens are few, one prospective, randomized trial found that oxygenation improved more quickly and survival was better in those who received trimethoprim-sulfamethoxazole. ... 

Nocardia infections have been treated successjully, but failures also have been reported. Although a combination of doxycycline and streptomycin or gentamicin is considered the treatment of choice for brucellosis, trimethoprim—sulfamethoxazole may be an effective substitute for the doxy-cyctine combination. Trimethoprim—sulfamethoxazole also has been used successjully for Whipple s disease, Stenotrophomonas maltophilia infection, and infection by the intestinal parasites Cyclospora and Isospora. 

Lee AJ, Maddix DS. Trimethoprim/sulfamethoxazole-induced hypoglycemia in a patient with acute renal failure. Ann Pharmacother (1997) 31, 727-32. 

Alberti-Flor, J.J., Hernandez, M.E., Ferrer, J.P., Howell, S., Jeffers, L. Fulminant liver failure and pancreatitis associated with the use of sulfamethoxazole-trimethoprim. Amer. X Gastroenterol. 1989 84 1577-1579... 

Ransohoff DF, Jacobs G. Terminal hepatic failure following a small dose of sulfamethoxazole-trimethoprim. Gastroenterology 1981 80(4) 816-19. 

Tasker PR, MacGregor GA, de Wardener HE. Use of co-trimoxazole in chronic renal failure. Lancet. 1975 May 31 1(7918) 1216-8. Bourgault AM, Van Scoy RE, Brewer NS, Rosenow EC.Trimethoprim with sulfamethoxazole for treatment of Infection with Pneumocystis carinii in renal insufficiency. Chest. 1978 Jul 74(1) 91-2. 

The mechanism differs from that underlying the sulfamethoxazole/trimethoprim interaction. Sulphonamides such as co-trimoxazole and sulfadiazine are known to cause renal dysfunction - interstitial nephritis and renal failure, which may -L excretion of methotrexate. Sulphonamides are also known to compete with methotrexate for renal elimination. Displacement from protein-binding sites of methotrexate is a minor contribution to the interaction... 

Phenytoin serum levels can be raised by co-trimoxazole, sulfame-thizole, sulfamethoxazole, sulfadiazine and trimethoprim. Phenytoin toxicity may develop in some cases. A single case of liver failure has been described in a patient taking phenytoin with co-trimoxazole. Sulfamethoxypyridazine, and sulfafurazole (sulflsoxazole) are reported not to interact... 

A child who was stable taking phenytoin and sultiame developed phenytoin toxicity within 48 hours of starting co-trimoxazole. Toxicity resolved when the antibacterial was changed to amoxicillin. A clinical study found that co-trimoxazole and trimethoprim can increase the phenytoin half-life by 39% and 51%, respectively, and decrease the mean metabolic clearance by 27% and 30%, respectively. Sulfamethoxazole alone had only a small effect on the half-life and did not affect the clearance of phenytoin. A case report describes fatal acute hepatic failure in a 60-year-old woman 10 days after starting co-trimoxazole and 14 days after starting phenytoin. This patient was also given cimetidine, which may raise phenytoin levels (see Phenytoin + H2-receptor antagonists , p.559). 

Co-trimoxazole (sulfamethoxazole/trimethoprim) increases ethinylestradiol levels. However, there are about IS anecdotal cases on record of contraceptive failure attributed to co-trimoxazole. There are also isolated cases of contraceptive failure attributed to various sulfonamides and trimethoprim. 

Ramsay CA (1973) Photosensitivity from nalidixic acid (abridged). Proc R Soc Med 6 747 Ramsay C, Obreshikova E (1974) Photosensitivity from nalidixic acid. Br J Dermatol 91 523 Ransohoff D (1981) Terminal Hepatic failure following a small dose of sulfamethoxazole-trimethoprim. Gastroenterology 80 816... 

Ransohoff DF, Jacobs G (1981) Terminal Hepatic Failure Following a Small Dose of Sulfamethoxazole-Trimethoprim. Gastroenterology 80 816 Rao KG (1974) Pseudotumor cerebri associated with nalidixic acid. Urology 4 204 Rea TH, Levan NE (1975) Erythema nodosum leprosum in a general hospital. Arch Dermatol 3 1575... 

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