Prophylaxis for Opportunistic Infections
Authors: Joel E. Gallant
Journal: Annals of Internal Medicine (1995)

Letters1 May 1995Prophylaxis for Opportunistic InfectionsJoel E. Gallant, Richard D. Moore, and Richard E. ChaissonJoel E. GallantUniversitats Krankenhaus Eppendorf, 20246 Hamburg, Germany. The Johns Hopkins University School of Medicine, Baltimore, MD 21205.Search for more papers by this author, Richard D. MooreUniversitats Krankenhaus Eppendorf, 20246 Hamburg, Germany. The Johns Hopkins University School of Medicine, Baltimore, MD 21205.Search for more papers by this author, and Richard E. ChaissonUniversitats Krankenhaus Eppendorf, 20246 Hamburg, Germany. The Johns Hopkins University School of Medicine, Baltimore, MD 21205.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-122-9-199505010-00018 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Drs. Albrecht and Stellbrink have reiterated a common concern about the use of dihydrofolate reductase inhibitors. We do not believe, however, that folate-containing vitamin supplements should be restricted in patients receiving TMP-SMX. Pneumocystis carinii lacks a folate transport system [1-3]; therefore, host folate does not interfere with the action of agents that inhibit tetrahydrofolate synthesis. Folate-containing foods and supplements have not been restricted in the numerous studies documenting the efficacy of TMP-SMX in preventing and treating P. carinii pneumonia, and no evidence suggests that patients receiving such supplements are more likely to experience prophylaxis failure. Restricting dietary or ...References1. Allegra CJ, Chabner BA, Tuazon CU, Ogata-Arakaki D, Baird B, Drake JC, et al. Trimetrexate for the treatment of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome. N Engl J Med. 1987; 317:978-85. Google Scholar2. Allegra CJ, Kovacs JA, Drake JC, Swan JC, Chabner BA, Masur H. Activity of antifolates against Pneumocystis carinii dihydrofolate reductase and identification of a potent new agent. J Exp Med. 1987; 165:926-31. Google Scholar3. Kovacs JA, Allegra CJ, Beaver J, Boarman D, Lewis M, Parrillo JE, et al. Characterization of de novo folate synthesis in Pneumocystis carinii and Toxoplasma gondii: potential for screening therapeutic agents. J Infect Dis. 1989; 160:312-20. Google Scholar4. Dannemann BR, McCutchan JA, Israelski DM, Antoniskis D, Leport C, Luft B, et al. Treatment of toxoplasmic encephalitis in patients with AIDS. A randomized trial comparing pyrimethamine plus clindamycin to pyrimethamine plus sulfonamides. Ann Intern Med. 1992; 116:33-43. Google Scholar5. Eliaszewics M, Lecomte I, de Sa M. Relation between decreasing serial CD4 lymphocyte count and outcome of toxoplasmosis in AIDS patients: a basis for primary prophylaxis (Abstract). In: Abstracts of the VI International Conference on AIDS, San Francisco; 1990. Google Scholar Author, Article, and Disclosure InformationAffiliations: Universitats Krankenhaus Eppendorf, 20246 Hamburg, Germany. The Johns Hopkins University School of Medicine, Baltimore, MD 21205. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byDetermination rate of the Staphylococcus spp. and Candida spp. on skin of children living with HIV infectionPneumocystis carinii induces ICAM-1 expression in lung epithelial cells through a TNF-α-mediated mechanism 1 May 1995Volume 122, Issue 9Page: 730-731KeywordsFolic acidFoodNutritionOpportunistic infectionsPneumocystisPneumoniaProphylaxisPyrimethamineToxoplasma gondiiToxoplasmosis ePublished: 15 August 2000 Issue Published: 1 May 1995 Copyright & PermissionsCopyright © 1995 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...