Trimethoprim-sulfamethoxazole therapy for Nocardia infections
R. A. Smego Jr, M. B. Moeller and H. A. Gallis
The optimal therapy for infections due to Nocardia species has not been
established. To assess the efficacy of trimethoprim-sulfamethoxazole
(TMP-SMX), we reviewed the records of 19 patients with Nocardia infections
seen at Duke University Medical Center, Durham, NC, who were treated with
this drug, either alone or in combination with other antibiotics or a
surgical procedure. Underlying diseases or therapy causing
immunosuppression were present in all but five cases. Sites of involvement
were lung (ten of 19), wound (two of 19), and brain (two of 19); five of 19
patients had disseminated disease. The mean duration of therapy was 7.2
months. Overall cure or improvement was achieved in 89% (17/19) of cases;
80% of patients with disseminated disease and 60% of those with CNS
involvement recovered. This experience, and accumulated clinical evidence
in the literature, indicates that TMP-SMX should be considered the
therapeutic drug of choice in infections due to Nocardia species.
