Management of adverse reactions to prophylactic trimethoprim-sulfamethoxazole in patients with human immunodeficiency virus infection

Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology
J Belchi-Hernandez, F J Espinosa-Parra

Abstract

In hospitals attended by patients with human immunodeficiency virus infection, adverse reactions are often observed to trimethoprim-sulfamethoxazole, particularly cutaneous reactions. Given the importance of this drug for prophylaxis we have attempted to establish a desensitization or tolerance protocol so that patients can continue the drug without repeated adverse reactions. We studied 34 HIV patients with adverse cutaneous reactions to trimethoprim-sulfamethoxazole, slight to moderate in nature but not life-threatening. Skin tests (prick and intradermal) were done in an attempt to rule out a mechanism of hypersensitivity. Subsequently, trimethoprim-sulfamethoxazole was administered orally in increasing doses beginning with trimethoprim, 0.2 mg, and sulfamethoxazole, 1 mg. The same dose was repeated after 12 hours and then doubled every 24 hours until the therapeutic dose was achieved. If adverse reactions appeared we maintained the last dose administered and administered antihistamines until the reactions cleared or improved. None of the patients had positive skin tests (immediate or delayed). Twenty- seven patients were satisfactorily desensitized. After a follow-up of 3 months, 25 patients were still incident-free on trime...Continue Reading

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Citations

Oct 13, 2000·Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology·S YoshizawaS Oka
Nov 4, 2000·Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology·P Greenberger
Jun 5, 2002·Journal of Clinical Pharmacology·William M O'NeilCraig K Svensson
Oct 12, 2010·Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology·UNKNOWN Joint Task Force on Practice ParametersUNKNOWN Joint Council of Allergy, Asthma and Immunology
Jun 12, 2013·Allergy·K SchererUNKNOWN ENDA, the European Network on Drug Allergy and the EAACI Drug Allergy Interest Group
May 17, 2005·Pigment Cell Research·Kohsuke AdachiTakashi Hirata
May 21, 2010·Chemical Research in Toxicology·Sidonie N LavergneDean J Naisbitt

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