Low-Dose Trimethoprim-Sulfamethoxazole Prophylaxis for Pneumocystis jirovecii Pneumonia in a Critically Ill Patient with HIV/TB Coinfection: Pharmacokinetics and Clinical Outcomes
Year: 2025
Type: article
Abstract: 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 ChinaCorrespondence: Jinmeng Li, Department of Pharmacy, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang Province, 310000, People’s Republic of China, Email [email protected]: 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
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7102330139
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