Low-dose trimethoprim-sulfamethoxazole for prophylaxis of

Background: Trimethoprim-sulfamethoxazole (TMP-SMX) is the recommended first-line prophylactic agent against Methods: We searched PubMed, Embase, Wanfang, China National Knowledge Infrastructure, Web of Science, and the Cochrane database for relevant articles from inception to 15 October 2024. Studies were included if they reported the safety and efficacy of using TMP-SMX in PJP prophylaxis in patients without HIV infection. The primary outcome was the discontinuation rate. We assessed study quality and performed sensitivity and subgroup analysis to explore potential heterogeneity among the included studies. Results: Seventeen studies with 4,890 patients were included. These studies were low to modest in quality. Overall, the incidence of PJP in the included studies was rare and was similar between the low- and standard-dose groups. However, the low-dose regimen significantly reduced the risk of discontinuation rate (odds ratio [OR] = 0.38; 95% CI, 0.27-0.52; Conclusion: Our findings suggested that a low-dose TMP-SMX regimen is safe and significantly reduces the discontinuation rate and total AEs compared to the standard regimen against PJP in HIV-uninfected patients. Thus, it is a potentially promising prophylactic regimen, and more well-designed, high-quality research should be conducted. Systematic Review Registration: https://inplasy.com/inplasy-2024-4-0084/.