• An immunocompromised patient with Nocardia brasiliensis pneumonia and empyema acquired disseminated disease due to Nocardia asteroides and died. The treatment of choice for pulmonary or disseminated nocardiosis is 6 to 12 g/day of sulfisoxazole (or adjusted dosage to achieve a serum level of 100 to 150 mg/L) continued for six to 18 months. Combination therapy may be beneficial in selected patients; if trimethoprim therapy is used with sulfonamides, higher than usual doses of trimethoprim may be required to achieve optimal antinocardial activity. When the condition of a patient with nocardiosis fails to improve on sulfonamide therapy, patient compliance should be questioned, serum sulfonamide levels should be measured, cultures and susceptibility studies should be repeated, and a search for sequestered pus should be made.
(Arch Intern Med 1983;143:383-385)
Stamm AM, McFall DW, Dismukes WE. Failure of Sulfonamides and Trimethoprim in the Treatment of Nocardiosis: Report of a Patient With Pneumonia and Empyema due to Nocardia brasiliensis and Disseminated Disease due to Nocardia asteroides. Arch Intern Med. 1983;143(2):383–385. doi:10.1001/archinte.1983.00350020213042
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