Oral trimethoprim-sulphamethoxazole levels in stable HIV-infected children
| dc.contributor.author | Zar, Heather J | |
| dc.contributor.author | Langdon, Grant | |
| dc.contributor.author | Apolles, Patti | |
| dc.contributor.author | Eley, Brian | |
| dc.contributor.author | Hussey, Gregory | |
| dc.contributor.author | Smith, Peter | |
| dc.date.accessioned | 2017-07-17T09:35:08Z | |
| dc.date.available | 2017-07-17T09:35:08Z | |
| dc.date.issued | 2006 | |
| dc.date.updated | 2016-01-12T10:13:15Z | |
| dc.description.abstract | Background. Effective treatment of Pneumocystis jiroveci pneumonia (PCP) requires therapeutic serum concentrations of 5 - 10 µg/ml trimethoprim (TMP); consequently intravenous trimethoprim-sulphamethoxazole (TMP-SMZ) is recommended therapy. However, oral therapy is desirable as the intravenous route is costly, time-consuming, more difficult to administer and carries a risk of needlestick injury. Objective. To investigate whether therapeutic TMP levels for treatment of PCP can be attained with oral therapy in HIVinfected children. Methods. A prospective dose-escalation study was undertaken of serum TMP levels attained following oral doses of TMP of 5 mg/kg, 10 mg/kg or 20 mg/kg in stable HIV-infected children. Children who received a 20 mg/kg dose were randomised to get a second dose (5 or 10 mg/kg TMP) at 6 hours. TMP levels were measured at baseline, peak (3 hours), and trough (6 hours) using liquid chromatography. An additional TMP level was taken at 9 hours in those who received a second TMP dose. Results. Median (25th - 75th percentile) peak serum TMP levels following a 5 mg/kg, 10 mg/kg or 20 mg/kg oral loading dose were 0.93 (0.5 - 1.5) µg/ml, 1.94 (1.4 - 2.2) µg/ml and 7.68 (6.1- 7.8) µg/ml respectively. Peak TMP levels at 9 hours after a second TMP dose of 5 or 10 mg/kg were 6.98 (3.4 - 8.8) µg/ml and 9.25 (8.2 - 10.3) µg/ml respectively. Conclusion. Therapeutic concentrations of TMP for treatment of P. jiroveci can be attained with an oral loading dose of 20 mg/kg and sustained with a second dose at 6 hours of either 5 mg or 10 mg/kg in stable HIV-infected children. | |
| dc.identifier | http://dx.doi.org/10.7196/SAMJ.1166 | |
| dc.identifier.apacitation | Zar, H. J., Langdon, G., Apolles, P., Eley, B., Hussey, G., & Smith, P. (2006). Oral trimethoprim-sulphamethoxazole levels in stable HIV-infected children. <i>South African Medical Journal</i>, http://hdl.handle.net/11427/24750 | en_ZA |
| dc.identifier.chicagocitation | Zar, Heather J, Grant Langdon, Patti Apolles, Brian Eley, Gregory Hussey, and Peter Smith "Oral trimethoprim-sulphamethoxazole levels in stable HIV-infected children." <i>South African Medical Journal</i> (2006) http://hdl.handle.net/11427/24750 | en_ZA |
| dc.identifier.citation | Zar, H., Langdon, G., Apolles, P., Eley, B., Hussey, G., & Smith, P. (2006). Oral trimethoprim-sulphamethoxazole levels in stable HIV-infected children. South African Medical Journal, 96(7), 627. | |
| dc.identifier.ris | TY - Journal Article AU - Zar, Heather J AU - Langdon, Grant AU - Apolles, Patti AU - Eley, Brian AU - Hussey, Gregory AU - Smith, Peter AB - Background. Effective treatment of Pneumocystis jiroveci pneumonia (PCP) requires therapeutic serum concentrations of 5 - 10 µg/ml trimethoprim (TMP); consequently intravenous trimethoprim-sulphamethoxazole (TMP-SMZ) is recommended therapy. However, oral therapy is desirable as the intravenous route is costly, time-consuming, more difficult to administer and carries a risk of needlestick injury. Objective. To investigate whether therapeutic TMP levels for treatment of PCP can be attained with oral therapy in HIVinfected children. Methods. A prospective dose-escalation study was undertaken of serum TMP levels attained following oral doses of TMP of 5 mg/kg, 10 mg/kg or 20 mg/kg in stable HIV-infected children. Children who received a 20 mg/kg dose were randomised to get a second dose (5 or 10 mg/kg TMP) at 6 hours. TMP levels were measured at baseline, peak (3 hours), and trough (6 hours) using liquid chromatography. An additional TMP level was taken at 9 hours in those who received a second TMP dose. Results. Median (25th - 75th percentile) peak serum TMP levels following a 5 mg/kg, 10 mg/kg or 20 mg/kg oral loading dose were 0.93 (0.5 - 1.5) µg/ml, 1.94 (1.4 - 2.2) µg/ml and 7.68 (6.1- 7.8) µg/ml respectively. Peak TMP levels at 9 hours after a second TMP dose of 5 or 10 mg/kg were 6.98 (3.4 - 8.8) µg/ml and 9.25 (8.2 - 10.3) µg/ml respectively. Conclusion. Therapeutic concentrations of TMP for treatment of P. jiroveci can be attained with an oral loading dose of 20 mg/kg and sustained with a second dose at 6 hours of either 5 mg or 10 mg/kg in stable HIV-infected children. DA - 2006 DB - OpenUCT DP - University of Cape Town J1 - South African Medical Journal LK - https://open.uct.ac.za PB - University of Cape Town PY - 2006 T1 - Oral trimethoprim-sulphamethoxazole levels in stable HIV-infected children TI - Oral trimethoprim-sulphamethoxazole levels in stable HIV-infected children UR - http://hdl.handle.net/11427/24750 ER - | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/11427/24750 | |
| dc.identifier.vancouvercitation | Zar HJ, Langdon G, Apolles P, Eley B, Hussey G, Smith P. Oral trimethoprim-sulphamethoxazole levels in stable HIV-infected children. South African Medical Journal. 2006; http://hdl.handle.net/11427/24750. | en_ZA |
| dc.language.iso | eng | |
| dc.publisher.department | Division of Child and Adolescent Psychiatry | en_ZA |
| dc.publisher.faculty | Faculty of Health Sciences | en_ZA |
| dc.publisher.institution | University of Cape Town | |
| dc.source | South African Medical Journal | |
| dc.source.uri | http://www.samj.org.za/index.php/samj | |
| dc.subject.other | HIV-infected children | |
| dc.subject.other | Pneumocystis jiroveci pneumonia | |
| dc.subject.other | Trimethoprim-sulphamethoxazole | |
| dc.subject.other | Oral therapy | |
| dc.title | Oral trimethoprim-sulphamethoxazole levels in stable HIV-infected children | |
| dc.type | Journal Article | en_ZA |
| uct.type.filetype | Text | |
| uct.type.filetype | Image | |
| uct.type.publication | Research | en_ZA |
| uct.type.resource | Article | en_ZA |