2025 Volume 14 Issue 1 Pages 3-8
Trimethoprim-sulfamethoxazole （TMP-SMX） is the first-line treatment for the prevention of pneumocystis pneumonia （PCP）; however, discontinuations due to side effects are common. Although package inserts and guidelines describe the appropriate dosage, the dosage for patients with immunologic renal diseases remains unclear.
The aim of this study was to survey the tolerability of low-dose TMP-SMX for the prevention of PCP in patients with immunological kidney disease. We included patients prescribed TMP-SMX for the prevention of PCP in immunological kidney disease between April 2016 and March 2024. Patients were divided into two groups according to the dose of TMP-SMX: a control dose group （four tablets/week） and low-dose group （two tablets/week）. We investigated the cumulative incidence of PCP and the cumulative discontinuation rate of TMP-SMX.
The study included 75 patients （10 in the control dose group and 65 in the low-dose group）. During the observation period, neither group experienced PCP, and the cumulative discontinuation rate of TMP-SMX, adjusted for competing risks, at 180 days was 30.0% （95% confidence interval 0.071-0.578） in the control group and 15.37% （95% confidence interval 0.075-0.259） in the low-dose group. The adjusted hazard ratio for the low-dose group compared with the control group was 0.397 （95% confidence interval 0.110-1.438, p = 0.160）.
The low-dose group had fewer discontinuations of TMP-SMX than the control dose group; however, the difference was not significant. The findings from this retrospective study suggest that low-dose TMP-SMX for preventing PCP in patients with immunologic kidney disease may offer better tolerability and a safer profile.
