Efficacy and safety of first-line therapy for pulmonary nocardiosis; trimethoprim-sulfamethoxazole versus alternative antibiotics

Respirology(2022)

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摘要
Abstract The recommended antibiotic for pulmonary nocardiosis (PN) is trimethoprim-sulfamethoxazole (TMP-SMZ). However, no comparative studies have assessed its efficacy and safety. We compared 180-day outcomes of first-line therapies for PN between fifty-two patients treated with TMP-SMZ (TS group [n = 18]) and with alternative antibiotics (non-TS group [n = 34]). Failure-free survival (FFS) was defined as the time from initiation to discontinuation of first-line therapy due to treatment failure including disease progression or death and adverse events. Overall survival (hazard ratio [HR] of TMP-SMZ, 2.96; p = 0.118) and the time to disease progression or death (HR of TMP-SMZ, 3.15; p = 0.136) did not differ significantly between the two groups. The incidence of adverse events was 61.1% (TS group) and 20.6% (non-TS group). The time to adverse events inducing treatment failure was significantly shorter (HR, 3.44; p = 0.021), and FFS was poorer in the TS group than in the non-TS group (HR, 3.33; p = 0.005). Multivariate Cox analysis revealed that TMP-SMZ administration was an independent predictor of treatment failure (HR, 3.16; p = 0.016). TMP-SMZ may not be an optimal antibiotic for first-line therapy for PN as it is inferior to alternative antibiotics in safety and associated with increased treatment failure.
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