臺大醫院-內科部;臺大醫學院;Lee, Kuan-YehKuan-YehLeeHuang, Chung-HaoChung-HaoHuangTang, Hung-JenHung-JenTangYang, Chia-JuiChia-JuiYangKo, Wen-ChienWen-ChienKoChen, Yen-HsuYen-HsuChenLee, Yi-ChienYi-ChienLeeCHIEN-CHING HUNG2018-09-102018-09-102012http://www.scopus.com/inward/record.url?eid=2-s2.0-84867604324&partnerID=MN8TOARShttp://scholars.lib.ntu.edu.tw/handle/123456789/369142Objectives: 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.100 bytestext/html[SDGs]SDG3clindamycin; 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 Adultjournal article10.1093/jac/dks283