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已发表论文
低剂量复方新诺明预防危重症 HIV/TB 合并感染患者肺孢子菌肺炎的药代动力学及临床结局
Authors Ma X, Zhang R, Zheng R , Cheng J, Wu C , Cai X, Li J
Received 20 June 2025
Accepted for publication 11 October 2025
Published 25 October 2025 Volume 2025:18 Pages 5489—5497
DOI https://doi.org/10.2147/IDR.S548625
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Hazrat Bilal
Xiaoqing Ma, Ruoying Zhang, Ren Zheng, Junjie Cheng, Chongyang Wu, Xinjun Cai, Jinmeng Li
Department of Pharmacy, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang Province, 310000, People’s Republic of China
Correspondence: Jinmeng Li, Department of Pharmacy, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang Province, 310000, People’s Republic of China, Email jinmeng608@163.com
Background: Pneumocystis jirovecii pneumonia (PJP) is a life-threatening opportunistic infection disease in immunocompromised patients, particularly those with advanced HIV and tuberculosis (TB) co-infection. Trimethoprim-sulfamethoxazole (TMP-SMZ) is recommended for PJP prophylaxis, but its pharmacokinetics (PK) and clinical efficacy in critically ill patients receiving multi-drug therapies (anti-TB, antiretroviral, and antifungals) remain poorly characterized.
Case Presentation: This study reported the PK profile, multi-drug management strategies and clinical outcomes of low-dose TMP-SMZ (a combined dose of 480 mg once daily, 50% of the standard prophylactic dose) for PJP prophylaxis in a critically ill patient with disseminated TB, advanced HIV (CD4+ count: 21 cells/μL), and concurrent infections. The patient received TMP-SMZ alongside anti-TB therapy (isoniazid, rifabutin, levofloxacin, linezolid), voriconazole, and antiretroviral therapy. Therapeutic drug monitoring (TDM) showed peak concentrations of sulfamethoxazole (SMZ) and trimethoprim (TMP) were 18.58 μg/mL and 0.48 μg/mL, with trough concentrations of 1.75 μg/mL and 0.03 μg/mL, respectively. No drug–drug interactions were observed with concurrent voriconazole. The patient achieved stable recovery and without PJP or TMP-SMZ-related adverse events occurred during treatment and 6-month follow-up.
Conclusion: This case reported the feasibility of low-dose TMP-SMZ for PJP prevention in high-risk, critically ill patients with HIV/TB coinfection, and described its PK characteristics. It provides a reference for optimizing prophylaxis in resource-limited settings or patients intolerant to standard regimens.
Keywords: TMP-SMZ, low-dose, pharmacokinetics, case report
Department of Pharmacy, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang Province, 310000, People’s Republic of China
Correspondence: Jinmeng Li, Department of Pharmacy, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang Province, 310000, People’s Republic of China, Email jinmeng608@163.com
Background: Pneumocystis jirovecii pneumonia (PJP) is a life-threatening opportunistic infection disease in immunocompromised patients, particularly those with advanced HIV and tuberculosis (TB) co-infection. Trimethoprim-sulfamethoxazole (TMP-SMZ) is recommended for PJP prophylaxis, but its pharmacokinetics (PK) and clinical efficacy in critically ill patients receiving multi-drug therapies (anti-TB, antiretroviral, and antifungals) remain poorly characterized.
Case Presentation: This study reported the PK profile, multi-drug management strategies and clinical outcomes of low-dose TMP-SMZ (a combined dose of 480 mg once daily, 50% of the standard prophylactic dose) for PJP prophylaxis in a critically ill patient with disseminated TB, advanced HIV (CD4+ count: 21 cells/μL), and concurrent infections. The patient received TMP-SMZ alongside anti-TB therapy (isoniazid, rifabutin, levofloxacin, linezolid), voriconazole, and antiretroviral therapy. Therapeutic drug monitoring (TDM) showed peak concentrations of sulfamethoxazole (SMZ) and trimethoprim (TMP) were 18.58 μg/mL and 0.48 μg/mL, with trough concentrations of 1.75 μg/mL and 0.03 μg/mL, respectively. No drug–drug interactions were observed with concurrent voriconazole. The patient achieved stable recovery and without PJP or TMP-SMZ-related adverse events occurred during treatment and 6-month follow-up.
Conclusion: This case reported the feasibility of low-dose TMP-SMZ for PJP prevention in high-risk, critically ill patients with HIV/TB coinfection, and described its PK characteristics. It provides a reference for optimizing prophylaxis in resource-limited settings or patients intolerant to standard regimens.
Keywords: TMP-SMZ, low-dose, pharmacokinetics, case report