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Butler-Laporte G, Smyth E, Amar-Zifkin A, et al. Low-Dose TMP-SMX in the Treatment of . Open Forum Infect Dis. 2020;7(5):ofaa112doi: 10.1093/ofid/ofaa112.
Butler-Laporte, G., Smyth, E., Amar-Zifkin, A., Cheng, M. P., McDonald, E. G., & Lee, T. C. (2020). Low-Dose TMP-SMX in the Treatment of . Open forum infectious diseases, 7(5), ofaa112. https://doi.org/10.1093/ofid/ofaa112
Butler-Laporte, Guillaume, et al. "Low-Dose TMP-SMX in the Treatment of ." Open forum infectious diseases vol. 7,5 (2020): ofaa112. doi: https://doi.org/10.1093/ofid/ofaa112
Butler-Laporte G, Smyth E, Amar-Zifkin A, Cheng MP, McDonald EG, Lee TC. Low-Dose TMP-SMX in the Treatment of . Open Forum Infect Dis. 2020 Apr 02;7(5):ofaa112. doi: 10.1093/ofid/ofaa112. eCollection 2020 May. PMID: 32391402; PMCID: PMC7200085.
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Open Forum Infect Dis. 2020 Apr 02;7(5):ofaa112. doi: 10.1093/ofid/ofaa112. eCollection 2020 May.

Low-Dose TMP-SMX in the Treatment of .

Open forum infectious diseases

Guillaume Butler-Laporte, Elizabeth Smyth, Alexandre Amar-Zifkin, Matthew P Cheng, Emily G McDonald, Todd C Lee

Affiliations

  1. Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada.
  2. Research Institute of the McGill University Health Centre, Montréal, Québec, Canada.
  3. Medical Libraries, McGill University Health Centre, Montréal, Québec, Canada.
  4. Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
  5. McGill Interdisciplinary Initiative in Infection and Immunity, McGill University Health Centre, Montréal, Québec, Canada.
  6. Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada.
  7. Clinical Practice Assessment Unit, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada.

PMID: 32391402 PMCID: PMC7200085 DOI: 10.1093/ofid/ofaa112

Abstract

METHODS: We conducted a systematic search in the Medline, Embase, and Cochrane Library databases from inception through March 2019 for peer-reviewed studies reporting on reduced doses of TMP-SMX (15 mg/kg/d of trimethoprim or less) for the treatment of PJP. PRISMA, MOOSE, and Cochrane guidelines were followed. Gray literature was excluded.

RESULTS: Ten studies were identified, and 6 were included in the meta-analysis. When comparing standard doses with reduced doses of TMP-SMX, there was no statistically significant difference in mortality (absolute risk difference, -9% in favor of reduced dose; 95% confidence interval [CI], -27% to 8%). When compared with standard doses, reduced doses of TMP-SMX were associated with an 18% (95% CI, -31% to -5%) absolute risk reduction of grade ≥3 adverse events.

CONCLUSIONS: In this systematic review, treatment of PJP with doses of ≤10 mg/kg/d of trimethoprim was associated with similar rates of mortality when compared with standard doses and with significantly fewer treatment-emergent severe adverse events. Although limited by the observational nature of the studies included, this review provides the most current available evidence for the optimal dosing of TMP-SMX in the treatment of PJP.

© The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

Keywords: HIV; Pneumocystis jirovecii; TMP-SMX; transplantation

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