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November 1994

Adverse Cutaneous Reactions to Trimethoprim-Sulfamethoxazole in Patients With the Acquired Immunodeficiency Syndrome and Pneumocystis carinii Pneumonia

Author Affiliations

From the Departement des Maladies Infectieuses, Parasitaires, Tropicales, et Santé Publique, Hôpital Pitié-Salpêtrière, Paris, France.

Arch Dermatol. 1994;130(11):1383-1386. doi:10.1001/archderm.1994.01690110049005

Background and Design:  Patients with the acquired immunodeficiency syndrome are predisposed to cutaneous drug reactions. The reasons are poorly understood and the circumstances in which such patients can be treated through hypersensitivity are a matter of discussion. We assessed the value of clinical and laboratory parameters for predicting trimethoprim-sulfamethoxazole—induced skin reactions and the effects of continued trimethoprim-sulfamethoxazole therapy in such patients. We retrospectively studied all episodes of nonhypoxemic Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome who were treated with trimethoprim-sulfamethoxazole.

Results:  No clinical or laboratory parameters were found to be predictive of trimethoprim-sulfamethoxazole-induced cutaneous reactions. Of 38 patients treated with trimethoprim-sulfamethoxazole, 18 (47%) developed cutaneous reactions; these occurred within a median of 11 days (range, 7 to 20 days). Of these 18 patients, 12 (67%) continued to be treated with trimethoprim-sulfamethoxazole through hypersensitivity. Trimethoprim-sulfamethoxazole treatment was continued in 19 (95%) of the 20 patients who did not develop cutaneous reactions (P=.067). The mean duration of trimethoprim-sulfamethoxazole therapy was shorter (18 days) in patients who developed skin reactions than in those who did not (20 days) (P=.016). Noncutaneous side effects accounted for all but one interruption of therapy.

Conclusion:  No clinical or laboratory parameters were found to be predictive of cutaneous reactions. By treating through hypersensitivity, 67% of our patients, who otherwise might have had to stop taking trimethoprim-sulfamethoxazole, were able to continue this essential drug therapy.(Arch Dermatol. 1994;130:1383-1386)