Acute psychosis related to use of trimethoprim/sulfamethoxazole in the treatment of HIV-infected patients with pneumocystis Jirovecii pneumonia: A multicentre, retrospective study
Resource
J. Antimicrob. Chemother., 67(11), 2749-2754
Journal
Journal of Antimicrobial Chemotherapy
Journal Volume
67
Journal Issue
11
Pages
2749-2754
Date Issued
2012
Author(s)
Lee, Kuan-Yeh
Huang, Chung-Hao
Tang, Hung-Jen
Yang, Chia-Jui
Ko, Wen-Chien
Chen, Yen-Hsu
Lee, Yi-Chien
Abstract
Objectives: A recent study reported that trimethoprim/sulfamethoxazole caused acute psychosis in four renal transplant patients with Pneumocystis jirovecii pneumonia. We aimed to investigate the incidence of and factors associated with trimethoprim/sulfamethoxazole-related acute psychosis in HIV-infected patients with P. jirovecii pneumonia. Methods: We reviewed the medical records of HIV-infected patients who presented with P. jirovecii pneumonia and received trimethoprim/sulfamethoxazole at six major hospitals in Taiwan from July 2009 to May 2011. Acute psychosis was defined as the occurrence of hallucinations or delusions following the initiation of trimethoprim/sulfamethoxazole during hospitalization. Results: During the study period, 135 patients receiving trimethoprim/sulfamethoxazole for P. jirovecii pneumonia were enrolled and 16 (11.9%; 95% CI, 6.3%-17.4%) developed acute psychosis after a median duration of 5 days of trimethoprim/sulfamethoxazole treatment (range, 3-11 days). The incidence increased from 0% (0/16) in patients who received a daily trimethoprim dose of ?12 mg/kg to 23.5% (4/17) in those who received a daily trimethoprim dose of >18 mg/kg. In multivariate logistic regression analysis, a higher daily dose of trimethoprim/sulfamethoxazole (OR, per 1 mg increase of trimethoprim, 1.40; 95% CI, 1.12-1.76; P = 0.0035) and use of adjunctive steroids (OR, 4.43; 95% CI, 1.14-17.15; P = 0.031) were associated with acute psychosis. Conclusions: In this case series, 11.9% of HIV-infected patients developed acute psychosis while receiving trimethoprim/sulfamethoxazole for P. jirovecii pneumonia. While the study was limited by its retrospective design, the risk appeared to increase with increasing daily dose of trimethoprim/sulfamethoxazole in those vulnerable patients with multiple risks for acute psychosis. ? The Author 2012. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.
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Other Subjects
clindamycin; cotrimoxazole; prednisone; primaquine; acute psychosis; adult; aged; antibiotic therapy; article; case study; drug dose increase; drug dose reduction; drug safety; drug substitution; drug withdrawal; female; hallucination; hospital patient; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; incidence; major clinical study; male; medical record review; multicenter study (topic); Pneumocystis pneumonia; retrospective study; treatment duration; Adult; Aged; Anti-Infective Agents; Female; HIV Infections; Humans; Male; Middle Aged; Multicenter Studies as Topic; Pneumocystis jirovecii; Pneumonia, Pneumocystis; Prevalence; Psychotic Disorders; Retrospective Studies; Taiwan; Trimethoprim-Sulfamethoxazole Combination; Young Adult
Type
journal article
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