PMID- 28722596 OWN - NLM STAT- MEDLINE DCOM- 20170911 LR - 20181113 IS - 1476-1645 (Electronic) IS - 0002-9637 (Print) IS - 0002-9637 (Linking) VI - 97 IP - 2 DP - 2017 Aug TI - Therapeutic Response in Adult Patients with Nonsevere Chronic Paracoccidioidomycosis Treated with Sulfamethoxazole-Trimethoprim: A Retrospective Study. PG - 556-562 LID - 10.4269/ajtmh.16-0255 [doi] AB - According to the Brazilian Consensus on Paracoccidioidomycosis (PCM), itraconazole is the drug of choice for treatment. However, the combination of sulfamethoxazole and trimethoprim (SMX-TMP) is most commonly used in clinical practice because of its higher availability in the public health services. The aims of this study were to evaluate the therapeutic response of patients with nonsevere chronic PCM to SMX-TMP and highlight the factors related to treatment failure. An adequate therapeutic response was defined as completely improved disease signs and symptoms after medication use for a minimum of 6 months, followed by normalized hematological and biochemical changes, radiological improvements, and negative mycological examination findings. Medical records were analyzed for 244 patients with nonsevere chronic PCM who were treated between 1998 and 2014. In total, 41.9% of the patients had PCM for >/= 8 months. Seven (2.9%) patients were coinfected with human immunodeficiency virus (HIV). The median (25%, 75% percentiles) treatment duration was 21 (10, 25) months. Adequate treatment adherence was reported by 68.3% of patients. In addition, 73.6% of patients exhibited an adequate therapeutic response. The majority (82.6%) of patients who were treated with SMX-TMP for > 24 months displayed an adequate therapeutic response, and the frequency of adequate therapeutic response gradually decreased as the duration of treatment decreased. Treatment nonadherence (P < 0.001) and PCM-HIV coinfection (P = 0.019) were factors associated with therapeutic failure. The study results support the good efficacy of SMX-TMP. Attention should be given to PCM-HIV coinfection, emphasizing the concern of a higher risk of PCM therapeutic failure in these patients. FAU - Nery, Andreia F AU - Nery AF AD - Julio Muller University Hospital, Federal University of Mato Grosso, Cuiaba, Brazil. FAU - Crepaldi, Natasha P AU - Crepaldi NP AD - Julio Muller University Hospital, Federal University of Mato Grosso, Cuiaba, Brazil. FAU - Rossi, Soraya B R S AU - Rossi SBRS AD - General University Hospital, University of Cuiaba, Cuiaba, Brazil. FAU - Tadano, Tomoko AU - Tadano T AD - Julio Muller University Hospital, Federal University of Mato Grosso, Cuiaba, Brazil. FAU - Leal-Santos, Fabio A AU - Leal-Santos FA AD - UNIVAG Universitary Center, Mato Grosso, Brazil. FAU - Hahn, Rosane Christine AU - Hahn RC AD - Research Laboratory, Faculty of Medicine, Federal University of Mato Grosso, Cuiaba, Brazil. FAU - Menezes, Valfredo M AU - Menezes VM AD - Julio Muller University Hospital, Federal University of Mato Grosso, Cuiaba, Brazil. FAU - Fontes, Cor Jesus F AU - Fontes CJF AD - Julio Muller University Hospital, Federal University of Mato Grosso, Cuiaba, Brazil. LA - eng PT - Journal Article DEP - 20170719 PL - United States TA - Am J Trop Med Hyg JT - The American journal of tropical medicine and hygiene JID - 0370507 RN - 8064-90-2 (Trimethoprim, Sulfamethoxazole Drug Combination) SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Brazil/epidemiology MH - Female MH - Humans MH - Male MH - Middle Aged MH - Paracoccidioidomycosis/*drug therapy/epidemiology MH - Retrospective Studies MH - Treatment Outcome MH - Trimethoprim, Sulfamethoxazole Drug Combination/*therapeutic use PMC - PMC5544063 EDAT- 2017/07/20 06:00 MHDA- 2017/09/12 06:00 PMCR- 2018/08/02 CRDT- 2017/07/20 06:00 PHST- 2017/07/20 06:00 [pubmed] PHST- 2017/09/12 06:00 [medline] PHST- 2017/07/20 06:00 [entrez] PHST- 2018/08/02 00:00 [pmc-release] AID - tpmd160255 [pii] AID - 10.4269/ajtmh.16-0255 [doi] PST - ppublish SO - Am J Trop Med Hyg. 2017 Aug;97(2):556-562. doi: 10.4269/ajtmh.16-0255. Epub 2017 Jul 19.