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participating institutions:
Johns Hopkins University AIDS Service, New York State DOH AIDS Institute, The CORE Center, Cook County Hospital



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Incidence and Determinants of Bacterial Infections in HIV-Positive Patients Receiving Anti-Pneumocystis carinii/Toxoplasma gondii Primary Prophylaxis Within a Randomized Clinical Trial [Murri R et al. JAIDS 2001; 27: 49]: The authors examine the incidence of bacterial infections (bacteremia, pneumonia, sinusitis and otitis) in patients randomized to TMP-SMX or dapsone-pyrimethamine for primary prophylaxis of PCP and TE. The total participants were 244, and the frequency of bacterial infections complications during the two-year follow-up was bacteremia - 22, pneumonia - 63 and sinusitis/otitis - 39. These complications were equally divided in the two groups. The authors conclude that TMP-SMX does not protect against bacterial infections.
Comment: This study seems to defy both logic and the results of several randomized trials of PCP prophylaxis that have consistently shown a reduction in bacterial infections [NEJM 1992;327: 1842; AIDS 1993;7:1687; Lancet 1999; 353: 1463]. The authors point out that their results are consistent with some, though not all, prior studies and that the antibacterial activity of dapsone and pyrimethamine is not known.
posted 7/3/2001





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