Sulfamethoxazole Susceptibility of Mycobacterium tuberculosis Isolates from HIV-Infected Ugandan Adults with Tuberculosis Taking Trimethoprim-Sulfamethoxazole Prophylaxis
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Date
2015
Journal Title
Journal ISSN
Volume Title
Publisher
Antimicrob Agents Chemother
Abstract
Alternative drugs are urgently needed to treat multidrug-resistant
(MDR) tuberculosis (TB). Given the difficulties of new
drug development, repurposing currently licensed antibiotics is
practical and efficient. Trimethoprim-sulfamethoxazole (SXT) is
a fixed-dose drug combination used worldwide as treatment and
prophylaxis for multiple infections. Sulfamethoxazole (SMX) is in
the sulfonamide class of antibiotics, which were explored as an
anti-TB treatment in the mid-20th century with early studies
showing potential value for the treatment of pulmonary and miliary
TB (1–5). More recently, Forgacs et al. reported defervescence
of a patient with pulmonary TB who was initially treated with SXT
alone and also demonstrated in vitro susceptibility to SXT in 43 of
44 Mycobacterium tuberculosis isolates (6). These drug susceptibility
results were independently confirmed in laboratory strains (7,
8) and in patient isolates demonstrating SMX to be the active
agent with MICs within achievable serum levels (9, 10). In addition,
Alsaad and colleagues reported the use of SXT as part of a
combination regimen used to treat 10 patients with MDR-TB in
the Netherlands (11). They also reported M. tuberculosis susceptibility
to SXT in 17 of 18 patients with TB-HIV coinfection; however,
only 1 was taking SXT prior to TB diagnosis (12). Given the
development of drug resistance when active TB is treated with a
single drug, there is concern for resistance to SMX among TBHIV-
coinfected patients taking SXT prophylaxis. To address this
concern, we performed drug susceptibility testing (DST) on M.
tuberculosis isolates obtained from pretreatment sputum specimens
of HIV-infected patients taking SXT prophylaxis at the time
of diagnosis of active TB.
Sputum isolates used for
Description
Keywords
Sulfamethoxazole, Mycobacterium tuberculosis, HIV, Ugandan Adults, Trimethoprim-Sulfamethoxazole Prophylaxis
Citation
Ogwang S, Good CE, Okware B, Nsereko M, Jacobs MR, Boom WH, Bark CM. 2015. Sulfamethoxazole susceptibility of Mycobacterium tuberculosis isolates from HIV-infected Ugandan adults with tuberculosis taking trimethoprimsulfamethoxazole prophylaxis. Antimicrob Agents Chemother 59:5844 –5846. doi:10.1128/AAC.01101-15.