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Journal of the International Association of Physicians in AIDS Care (JIAPAC)
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1545109709333112v1
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Article

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

T. M. Chiller, MD, MPH, C. S. Polyak, MD, MPH*, J. T. Brooks, MD, J. Williamson, ScD, MS, B. Ochieng, HDMLS, Y. P. Shi, MD, MSc, P. Ouma, MPH, HDMLS, C. Greene, MD, M. Hamel, MD, J. Vulule, PhD, C. Bopp, MS, L. Slutsker, MD, MPH, and E. Mintz, MD, MPH

* To whom correspondence should be addressed. E-mail: cpolyak{at}u.washington.edu.


  Abstract

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.

First published on April 8, 2009, doi:10.1177/1545109709333112

Journal of the International Association of Physicians in AIDS Care (JIAPAC) 2009;8:165.

A more recent version of this article appeared on May 1, 2009

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