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  • Title: Therapeutic failure of trimethoprim/sulfamethoxazole in the treatment of Pneumocystis carinii pneumonia.
    Author: al-Tawfiq JA, Sorensen SJ, Cushing HE.
    Journal: Ann Pharmacother; 1999 Apr; 33(4):413-5. PubMed ID: 10332530.
    Abstract:
    OBJECTIVE: To report a case of failure of treatment of Pneumocystis carinii pneumonia (PCP) with trimethoprim/sulfamethoxazole (TMP/SMX) in a patient with HIV infection, despite an adequate serum SMX concentration. CASE SUMMARY: A 52-year-old white man was treated with TMP/SMX for PCP. After discharge he returned to the hospital with worsening of the PCP despite a serum SMX concentration of 60 micrograms/mL 18 hours after his last dose of TMP/SMX. DISCUSSION: PCP is one of the most common complications of HIV infection. TMP/SMX is the drug of choice for prophylaxis and treatment. The causes of therapeutic failure with this agent are not well documented. CONCLUSIONS: Alternative therapies to TMP/SMX should be seriously considered if the serum concentrations are therapeutic and the patient is not clinically improved.
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