Does trimethoprim-sulfamethoxazole prophylaxis for HIV induce bacterial resistance to other antibiotic classes? Results of a systematic review.
Clin Infect Dis
; 52(9): 1184-94, 2011 May.
Article
in En
| MEDLINE
| ID: mdl-21467024
ABSTRACT
BACKGROUND:
Trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis has long been recommended for immunosuppressed HIV-infected adults and children born to HIV-infected women. Despite this, many resource-limited countries have not implemented this recommendation, partly because of fear of widespread antimicrobial resistance not only to TMP-SMX, but also to other antibiotics. We aimed to determine whether TMP-SMX prophylaxis in HIV-infected and/or exposed individuals increases bacterial resistance to antibiotics other than TMP-SMX.METHODS:
A literature search was conducted in Medline, Global Health, Embase, Web of Science, ELDIS, and ID21.RESULTS:
A total of 501 studies were identified, and 17 met the inclusion criteria. Only 8 studies were of high quality, of which only 2 had been specifically designed to answer this question. Studies were classified as (1) studies in which all participants were infected and/or colonized and in which rates of bacterial resistance were compared between those taking or not taking TMP-SMX and (2) studies comparing those who had a resistant infection with those who were not infected. Type 1 studies showed weak evidence that TMP-SMX protects against resistance. Type 2 studies provided more convincing evidence that TMP-SMX protects against infection.CONCLUSION:
There was some evidence that TMP-SMX prophylaxis protects against resistance to other antibiotics. However, more carefully designed studies are needed to answer the question conclusively.
Full text:
1
Database:
MEDLINE
Main subject:
Bacterial Infections
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HIV Infections
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Trimethoprim, Sulfamethoxazole Drug Combination
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AIDS-Related Opportunistic Infections
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Antibiotic Prophylaxis
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Drug Resistance, Bacterial
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Anti-Bacterial Agents
Type of study:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prevalence_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Systematic_reviews
Limits:
Adult
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Child
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Child, preschool
/
Female
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Humans
Language:
En
Year:
2011
Type:
Article