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Daily Trimethoprim-Sulfamethoxazole Prophylaxis Rapidly Induces Corresponding Resistance Among Intestinal Escherichia coli of HIV-Infected Adults in Kenya

Centers for Disease Control and Prevention, Atlanta, Georgia

C.S. Polyak, MD, MPH

Centers for Disease Control and Prevention, Atlanta, Georgia, cpolyak{at}u.washington.edu

J.T. Brooks, MD

Centers for Disease Control and Prevention, Atlanta, Georgia

J. Williamson, ScD, MS

Centers for Disease Control and Prevention, Atlanta, Georgia

B. Ochieng, HDMLS

Center for Vector Biology and Control Research, KEMRI, Kisumu, Kenya

Y.P. Shi, MD, MSc

Centers for Disease Control and Prevention, Atlanta, Georgia

P. Ouma, MPH, HDMLS

Center for Vector Biology and Control Research, KEMRI, Kisumu, Kenya

C. Greene, MD

Centers for Disease Control and Prevention, Atlanta, Georgia

M. Hamel, MD

Centers for Disease Control and Prevention, Atlanta, Georgia

J. Vulule, PhD

Center for Vector Biology and Control Research, KEMRI, Kisumu, Kenya

C. Bopp, MS

Centers for Disease Control and Prevention, Atlanta, Georgia

L. Slutsker, MD, MPH

Center for Vector Biology and Control Research, KEMRI, Kisumu, Kenya

E. Mintz, MD, MPH

Centers for Disease Control and Prevention, Atlanta, Georgia

Background. Trimethoprim-sulfamethoxazole (TMP-SMZ) has been recommended by World Health Organization (WHO) as daily prophylaxis for Africans with AIDS to prevent opportunistic infections. Daily TMP-SMZ may reduce its susceptibility to commensal intestinal Escherichia coli (E coli), increasing the burden of TMP-SMZ-resistant pathogens. Methods. Participants received either daily TMP-SMZ (CD4 <350 cells/mm³) or daily multivitamins (MVIs; CD4 350 cells/mm³) for 6 months. Stool was collected at baseline, 2 weeks, 2 months, and 6 months. A random E coli was tested for susceptibility. Results. Baseline prevalence of TMP-SMZ resistance ranged from 71% to 81% and was not different across CD4 strata. At 2 weeks, prevalence of TMP-SMZ-resistant E coli increased significantly from 78% to 98% (P < .001) among persons taking daily TMP-SMZ and did not change among persons taking MVIs. Conclusions. Daily prophylaxis with TMP-SMZ induced in vivo resistance to the drug after 2 weeks. Empiric therapy for diarrhea with agents other than TMP-SMZ should be considered for HIV-infected persons receiving daily TMP-SMZ prophylaxis.

Key Words: trimethoprim-sulfamethoxazole • Kenya • Escherichia coli • HIV

This version was published on May 1, 2009

Journal of the International Association of Physicians in AIDS Care (JIAPAC), Vol. 8, No. 3, 165-169 (2009)
DOI: 10.1177/1545109709333112


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