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Evidence summaries

Cotrimoxazole for Opportunistic Infections of HIV/AIDS in Patients with Previous History of Hypersensitivity to Cotrimoxazole

Cotrimoxazole desensitization may result in fewer treatment stoppages and side effects than rechallenge in HIV-infected adult patients who had a previous mild or moderate reaction to cotrimoxazole. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 3 studies with a total of 268 subjects. Meta-analysis of these studies found a beneficial effect of using a desensitization protocol over a rechallenge protocol at six months of follow-up for preventing discontinuation of cotrimoxazole (number needed to treat (NNT) 7.14, 95% confidence interval (CI) 4.0-33.0), and for lower incidence of overall hypersensitivity (NNT 4.55, 95% CI 3.03-9.09). No severe hypersensitivity reactions occurred for either protocol in the three studies.

Comment: The quality of evidence is downgraded by study quality; inadequate allocation concealment and by imprecise results; few patients and wide confidence intervals.

    References

    • Lin D, Li WK, Rieder MJ. Cotrimoxazole for prophylaxis or treatment of opportunistic infections of HIV/AIDS in patients with previous history of hypersensitivity to cotrimoxazole. Cochrane Database Syst Rev 2007 Apr 18;(2):CD005646. [PubMed]

Primary/Secondary Keywords