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已发表论文
低剂量复方新诺明（甲氧苄啶-磺胺甲噁唑）预防非 HIV、非移植免疫抑制患者肺孢子菌肺炎（PJP）的有效性和安全性：一项真实世界队列研究
Authors Cao D , Mo J, Wang H, Jiang J, Cao M, Zhu Z, Zhou H
Received 25 June 2025
Accepted for publication 14 October 2025
Published 25 October 2025 Volume 2025:18 Pages 5451—5460
DOI https://doi.org/10.2147/IDR.S549404
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Hazrat Bilal
Dakui Cao,1 Juanfen Mo,2 Haiqin Wang,1 Jianping Jiang,1 Mengqing Cao,1 Ziyi Zhu,1 Hua Zhou3
1Department of Respiratory and Critical Care Medicine, The Second Hospital of Jiaxing, Jiaxing, Zhejiang Province, 314000, People’s Republic of China; 2Central Laboratory, The Second Hospital of Jiaxing, Jiaxing, Zhejiang Province, 314000, People’s Republic of China; 3Department of Respiratory Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310003, People’s Republic of China
Correspondence: Hua Zhou, Department of Respiratory Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, People’s Republic of China, Email zhouhua1@zju.edu.cn
Purpose: To evaluate the noninferiority and safety of low-dose trimethoprim-sulfamethoxazole (TMP-SMZ, 200/40 mg qd) with respect to conventional-dose TMP-SMZ in preventing Pneumocystis jirovecii pneumonia (PJP) in non-human immunodeficiency virus (HIV), non-transplant, immunosuppressed patients.
Methods: This retrospective cohort study included patients who received PJP-preventing therapy at the First Affiliated Hospital of Zhejiang University School of Medicine from April 2021 to December 2023. The patients were divided into low-dose group (TMP-SMZ 200/40 mg qd, n=57) and conventional-dose group (400/80 mg qd, n=65). The primary endpoint was the 90-day incidence of PJP, and the secondary endpoints included all-cause mortality and adverse drug events (assessed on the basis of the Common Terminology Criteria for Adverse Events (CTCAE) 5.0 and Kidney Disease: Improving Global Outcomes (KDIGO) criteria).
Results: No patients in either group developed PJP within 90 days (risk difference (RD) = 0, 95% confidence interval (CI): − 0.05 to 0.05). There was no statistically significant difference in the incidence of adverse reactions (ARs), such as hematologic toxicity (granulocytopenia: 5.26% vs 1.54%, p=0.339), liver injury, and kidney injury, between the low-dose group and the conventional-dose group. The median survival time was 193 days in the low-dose group vs 130 days in the conventional-dose group (p=0.312).
Conclusion: In non-HIV, non-transplant, immunosuppressed patients, the efficacy of low-dose TMP-SMZ (200/40 mg/d) in the prevention of PJP was not inferior to that of conventional-dose TMP-SMZ, and the safety profiles of the two doses were equivalent.
Keywords: trimethoprim-sulfamethoxazole, Pneumocystis jirovecii pneumonia, immunosuppression
1Department of Respiratory and Critical Care Medicine, The Second Hospital of Jiaxing, Jiaxing, Zhejiang Province, 314000, People’s Republic of China; 2Central Laboratory, The Second Hospital of Jiaxing, Jiaxing, Zhejiang Province, 314000, People’s Republic of China; 3Department of Respiratory Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310003, People’s Republic of China
Correspondence: Hua Zhou, Department of Respiratory Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, People’s Republic of China, Email zhouhua1@zju.edu.cn
Purpose: To evaluate the noninferiority and safety of low-dose trimethoprim-sulfamethoxazole (TMP-SMZ, 200/40 mg qd) with respect to conventional-dose TMP-SMZ in preventing Pneumocystis jirovecii pneumonia (PJP) in non-human immunodeficiency virus (HIV), non-transplant, immunosuppressed patients.
Methods: This retrospective cohort study included patients who received PJP-preventing therapy at the First Affiliated Hospital of Zhejiang University School of Medicine from April 2021 to December 2023. The patients were divided into low-dose group (TMP-SMZ 200/40 mg qd, n=57) and conventional-dose group (400/80 mg qd, n=65). The primary endpoint was the 90-day incidence of PJP, and the secondary endpoints included all-cause mortality and adverse drug events (assessed on the basis of the Common Terminology Criteria for Adverse Events (CTCAE) 5.0 and Kidney Disease: Improving Global Outcomes (KDIGO) criteria).
Results: No patients in either group developed PJP within 90 days (risk difference (RD) = 0, 95% confidence interval (CI): − 0.05 to 0.05). There was no statistically significant difference in the incidence of adverse reactions (ARs), such as hematologic toxicity (granulocytopenia: 5.26% vs 1.54%, p=0.339), liver injury, and kidney injury, between the low-dose group and the conventional-dose group. The median survival time was 193 days in the low-dose group vs 130 days in the conventional-dose group (p=0.312).
Conclusion: In non-HIV, non-transplant, immunosuppressed patients, the efficacy of low-dose TMP-SMZ (200/40 mg/d) in the prevention of PJP was not inferior to that of conventional-dose TMP-SMZ, and the safety profiles of the two doses were equivalent.
Keywords: trimethoprim-sulfamethoxazole, Pneumocystis jirovecii pneumonia, immunosuppression