ArticleEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology2026
Reassessing the efficacy and safety of trimethoprim-sulfamethoxazole for Pneumocystis jirovecii pneumonia: a retrospective study.
Article in European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThe conventional dose of trimethoprim-sulfamethoxazole (TMP-SMX) for treating patients with Pneumocystis jirovecii pneumonia (PCP) has been associated with a higher incidence of adverse events. This study aimed to evaluate the safety and efficacy of conventional and low-dose TMP-SMX regimens in such patients.
methodsA retrospective study was conducted on patients with non-human immunodeficiency virus (HIV)-associated PCP treated with TMP-SMX from January 2020 to February 2024. Clinical characteristics and treatment outcomes were collected. Patients were divided into conventional-dose (TMP, 15–20 mg/kg/day) and low-dose (TMP, < 15 mg/kg/day) groups. Univariate and multivariable logistic regression analyses were performed.
resultsThe study included 140 patients, with 68 receiving conventional-dose TMP-SMX (TMP, 15–20 mg/kg/day) and 72 receiving low-dose TMP-SMX (TMP, < 15 mg/kg/day). Non-significant differences were observed in the length of hospital stay (p = 0.834) and 30-day mortality (p = 0.134) between the two groups. The overall adverse events rate was significantly higher in the conventional-dose group (p = 0.027). Acute kidney injury occurred in 15.7% of patients (22/140) and hyperkalemia in 14.3% (20/140) without significant differences between groups. Elevated alanine aminotransferase/aspartate aminotransferase occurred in 16.2% of the conventional-dose group and 2.8% of the low-dose group (p = 0.006). Multivariable logistic regression analysis identified baseline creatinine clearance (p = 0.046) and TMP-SMX daily dose (p = 0.017) as independent risk factors for total adverse events.
conclusionsLow-dose TMP-SMX for PCP treatment provides satisfactory outcomes with fewer adverse events. Adjusting TMP-SMX dosage may represent a valuable therapeutic optimization strategy.
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