Cotrimoxazole
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Lack of efficacy: 2 case reports In a case series two men, aged 33 years and 48 years were described, who exhibited lack of effect of cotrimoxazole, indicated for Pneumocystisjirovecii pneumonia [routes and dosages not stated]. Case 1: The 33-year-old man, who had HIV, presented with dyspnoea, fever and odynophagia. After investigations on hospital admission, he was diagnosed with Pneumocystis jirovecii pneumonia. He then started receiving cotrimoxazole [trimethoprim/ sulfamethoxazole]. Concomitantly, he was receiving various other medications. Despite cotrimoxazole treatment, his pancytopenia worsened. He was noted to have inflamed marrow and partial necrosis. Then, he received unspecified granulocyte colony stimulating factors. On day 22 of hospital admission, his hypoxemia worsened. He developed pneumomediastinum. A newly formed cystic lesions in his both lung fields were present. His pneumomediastinum was treated conservatively with high oxygen supply. However, his general condition deteriorated. On day 23 of hospital admission, he received pentamidine. On day 25, his oxygen requirement increased. On day 26, he died [cause of death not stated]. Case 2: The 48-year-old man presented with insidious dyspnoea. He had underlying HIV. After investigations on hospital admission, he was diagnosed with Pneumocystis jirovecii pneumonia and Staphylococcus aureus infection. Over time, he developed respiratory failure. He then started receiving cotrimoxazole [trimethoprim/sulfamethoxazole] and unspecified corticosteroids. On hospital day 4 he developed sudden chest pain radiating to the shoulder and neck. The air lining the cardiac border indicated development of pneumomediastinum. Newly developed cystic changes, parenchymal tear and bronchiectatic change were noted. His pneumomediastinum was treated high oxygen supply. On hospital day 13, his pneumomediastinum, bronchiectasis and parenchymal tear aggravated. Subsequently, cotrimoxazole was switched to pentamidine. However, he was noted to have nausea, vomiting and hypoglycaemia. Antibiotic-therapy was further changed to primaquine and clindamycin. Eventually, his dyspnoea improved. On day 42, he was discharged, and was subjected to further follow-up in the outpatient clinic. Cho J-Y, et al. Newly formed cystic lesions for the development of pneumomediastinum in Pneumocystis jirovecii pneumonia. BMC Infectious Diseases 9: 171, No. 171, 803499277 2009. Available from: URL: http://doi.org/10.1186/1471-2334-9-171
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