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February 1983

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

Author Affiliations

From the Divisions of Infectious Diseases (Drs Stamm and Dismukes), and General Medicine (Dr Stamm), Department of Medicine, University of Alabama, Birmingham; and the Department of Medicine, Lyster US Army Community Hospital, Fort Rucker, Ala (Dr McFall).

Arch Intern Med. 1983;143(2):383-385. doi:10.1001/archinte.1983.00350020213042

• 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)