ArticleInfection2025
Trimethoprim-sulfamethoxazole dosing and outcomes of pulmonary nocardiosis.
Article in Infection, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- Omitting the Eradication Phase of Treatment of Adults with Melioidosis: A Pilot, Single-Center Randomized Controlled Trial.Open forum infectious diseases · 2026Article
- Appropriateness and Abuse of Antipyretics, Anti-Inflammatory Drugs and Antibiotics in Children and Adults.Antibiotics (Basel, Switzerland) · 2026Review
- Pulmonary actinomycosis and pulmonary nocardiosis mimicking lung cancer: A case series and narrative review.Biomolecules & biomedicine · 2026Review
- NCY-1 β-Lactamase Activity Correlates With Antimicrobial Susceptibility of a Clinical Strain of Nocardia cyriacigeorgica.MicrobiologyOpen · 2026Article
- PulmonaryCase reports in infectious diseases · 2026Article
- Toxicity-guided dose modification for disseminatedFrontiers in pharmacology · 2026Article
- Nocardia Isolation in People with Cystic Fibrosis and Non-CF Bronchiectasis: A Multicenter Italian Study.Antibiotics (Basel, Switzerland) · 2025Article
- Massive hemoptysis as the sentinel symptom: a case report of pulmonary nocardiosis in an immunocompetent patient.Frontiers in medicine · 2025Article
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Authors and funding
10 authors.
Funding
Abstract
backgroundNocardia 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.
methodsWe 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.
resultsNinety-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).
conclusionsLow- 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.
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