Use of trimethoprim-sulfamethoxazole for treatment of infections due to nocardia

Richard J. Wallace, Edward J. Septimus, Temple W. Williams, Richard H. Conklin, Terry K. Satterwhite, Margaret B. Bushby, Donna C. Hollowell

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159 Scopus citations


Trimethoprim-sulfamethoxazole (TMP-SMZ) was used for treatment of 34 patients with pulmonary or cutaneous nocardiosis. Of nine patients with primary cutaneous disease, eight had rapid resolution of their infection after short-term therapy and none have relapsed after a follow-up of more than six months. The 25 patients with pulmonary nocardiosis had a good clinical response, but three of five (60%) who completed less than three months of therapy relapsed within four weeks. Of the 10 patients who completed four to six months of therapy, only one (10%) relapsed and this relapse was due to drug resistance. By the method of serial dilution in agar, 95010 of 59 isolates of Nocardia had MICs of SMZ of < 25 I-μg/ml. Fewer than 20% were susceptible to 2.5 μg of TMP/ml. Synergy between TMP and SMZ was usually present with ratios of TMP to SMZ of 1:5,1:1, or 5:1, but was less common at a ratio of 1:20. Disk susceptibility testing was easy to perform and readily separated sensitive from resistant strains. TMP-SMZ is highly effective for the treatment of nocardiosis, but the question of whether it is more effective clinically than a sulfonamide alone remains unanswered.

Original languageEnglish (US)
Pages (from-to)315-325
Number of pages11
JournalReviews of Infectious Diseases
Issue number2
StatePublished - Mar 1982

ASJC Scopus subject areas

  • Microbiology (medical)


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