Trimethoprim-Sulfamethoxazole in Listeria monocytogenes Meningitis
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Letters and Corrections1 June 1985Trimethoprim-Sulfamethoxazole in Listeria monocytogenes MeningitisGERMAINE JACQUETTE, M.D., PENELOPE H. DENNEHY, M.D.GERMAINE JACQUETTE, M.D.Search for more papers by this author, PENELOPE H. DENNEHY, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-102-6-866_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: In their review of the use of trimethoprim-sulfamethoxazole in the treatment of bacterial meningitis, Levitz and Quintiliani (1) conclude that it may play a major role in treatment of resistant gram-negative and Staphylococcus aureus meningitides. They also cite two reports of successful use of the drug in Listeria monocytogenes meningitis. We report our experience and note additional cases in the literature indicating that trimethoprim-sulfamethoxazole should be considered in the treatment of Listeria meningitis in appropriate situations.A 73-year-old man with a history of resected renal cell Carcinoma, prostatectomy, recurrent urinary tract infections, and mild renal insufficiency was...References1. LEVITZQUINTILIANI RR. Trimethoprim-sulfamethoxazole for bacterial meningitis. Ann Intern Med. 1984;100:881-90. LinkGoogle Scholar2. IWARSONLIDIN-JAMSONSVENSSON SGR. Listeria meningitis in the non-compromised host. Infection. 1977;5:204-6. CrossrefMedlineGoogle Scholar3. SCHEERHIRSCHMAN MS. Oral and ambulatory therapy of Listeria bacteremia and meningitis with trimethoprim-sulfamethoxazole. Mt Sinai Med J. 1982;49:411-4. MedlineGoogle Scholar4. LARSSONCRONBERGWINBLAD SSS. Clinical aspects of 64 cases of juvenile and adult listeriosis in Sweden. Acta Med Scand. 1978;204:503-8. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByListeria Rhomboencephalitis in an Immunocompetent HostListeria monocytogenes encephalitis mimicking west nile encephalitisAcute Bacterial Meningitis in Adults: A 12-Year ReviewCentral Nervous System Infection with Listeria monocytogenes : 33 Yearsʼ Experience at a General Hospital and Review of 776 Episodes from the LiteratureMeningites bacteriennes non tuberculeuses du sujet age de plus de 60 ansCentral Nervous System Infections in the Compromised HostTraitement des méningo-encéphalites à Listeria monocytogenes de l'adulte par le cotrimoxazole en monothérapie 1 June 1985Volume 102, Issue 6Page: 866-867KeywordsBacterial meningitisDrugsMeningitisProstatectomyRenal cell carcinomaStaphylococcus aureus Issue Published: 1 June 1985 PDF DownloadLoading ...Keywords:
Sulfamethoxazole
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It is impossible to test accurately bacterial susceptibility to the trimethoprim-sulfamethoxazole combination co-trimoxazole with a single combined susceptibility disk. However, a variety of factors still affect the result even when separate trimethoprim and sulfamethoxazole disks are used. Experiments with separate disks showed that the optimum conditions for testing the susceptibilities of enterobacteria to these drugs were to flood-seed an agar plate with an inoculum of 10(4) to 10(5) organisms per ml, take off the excess liquid, and place a disk of 1 microgram of trimethoprim and another of 50 micrograms of sulfamethoxazole on the surface of the agar with their centers exactly 25 mm apart. This method not only allowed the determination of resistance but also distinguished synergy.
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A total of 118 children between 6 months and 10 years of age with acute urinary tract infection were treated in a random; double-blind manner with 12 mg/kg/day of trimethoprim-sulfamethoxazole (61 patients) or 50 mg/kg/day of sulfamethoxazole (57 patients) for ten days. Mean trimethoprim and sulfamethoxazole susceptibilities of Escherichia coli isolated from these patients were 1.2 and 0.6 microgram/ml, respectively. Mean serum concentrations of trimethoprim and sulfamethoxazole were 1.8 and 62 microgram/ml, respectively, one hour after the dose. Of the children who completed the ten days of prescribed medication, clinical and bacteriological cure was confirmed immediately after treatment for all but one patient in each group. Most patients in each treatment group with recurrent infections had underlying urological abnormalities. Severe hematological, renal, or hepatic toxicity requiring interruption of treatment was not encountered. No advantage of trimethoprim-sulfamethoxazole over sulfamethoxazole alone for acute urinary tract infection was demonstrated.
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Sulfamethoxazole and trimethoprim have been used for decades, yet high dosages are rarely reported. We aimed to measure blood concentrations of both molecules in this situation. Between 2002 and 2010, 22 patients received two tablets of co-trimoxazole three times a day, equivalent to a daily dosage of 2400 mg of sulfamethoxazole and 480 mg of trimethoprim. The trimethoprim and sulfamethoxazole concentrations were determined 3 h after administration using ion-paired HPLC. In the presence of a negative control, which yielded no peaks at the retention times for trimethoprim and sulfamethoxazole, the mean ± SD value for sulfamethoxazole concentration was 161.01 ± 69.154 mg/L and the mean ± SD value for trimethoprim was 5.788 ± 2.74 mg/L. These concentrations are largely above the trimethoprim and sulfamethoxazole MIC distributions as well as the trimethoprim resistance clinical breakpoint (4 mg/L) reported by EUCAST in 2012 for most bacterial pathogens, including Gram-positive species such as Staphylococcus aureus. Our results support proposing a high-dosage regimen of co-trimoxazole as a suitable alternative for methicillin-resistant S. aureus infections.
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Trimethoprim–sulfamethoxazole (TMP-SMX) is a fixed combination of two antimicrobial agents — a diaminopyrimidine (trimethoprim) and a sulfonamide (sulfamethoxazole) — purposely chosen to provide sequential and synergistic inhibition of bacterial folate metabolism. Although a parenteral formulation of this combination is currently under evaluation, TMP-SMX is generally available only for oral use. It is marketed in a fixed drug ratio of one part TMP to five parts SMX (single-strength tablets contain 80 mg of TMP and 400 mg of SMX, double-strength tablets contain 160 mg of TMP and 800 mg of SMX, and an oral suspension contains 40 mg of TMP and . . .
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Simultaneous solubility and dissolution rate of sulfamethoxazole and trimethoprim in binary mixture.
The solubilities of trimethoprim in solutions with different pH values decreased in the presence of sulfamethoxazole, while that of the latter increased in the presence of the first. The dissolution rate of trimethoprim in HCl (0.1 mol/1) was the same in the presence and absence of sulfamethoxazole. That of sulfamethoxazole however, decreased in the presence of trimethoprim. The different reasons were explained.
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