Reviewed by Mary Fortini, DO, University of Utah
Low-dose (LD) trimethoprim/sulfamethoxazole (TMP/SMX) (8-12mg/kg/day) vs high-dose (HD) TMP/SMX (>12mg/kg/day) in the treatment of Stenotrophomonas maltophilia pneumonia was reviewed retrospectively over a 10-year period in a tertiary care hospital. There was no difference in the primary outcome of clinical success (resolution or improvement in the clinical features of infection and no further S. maltophilia-specific treatment required) between patients who received LD vs HD TMP/SMX (55% and 63%, respectively, p=0.53). The LD group (n=20) did have higher SOFA scores (median: 8.5 [IQR: 4.5-11.5]) than the HD group (n=75) SOFA scores (median: 4 [IQR: 2-7]); however, when correcting for this confounding variable, there was still no statistical significance noted in the primary outcome. As there were limitations to this study, particularly the small sample size, and many polymicrobial respiratory samples reviewed, further studies are needed to determine if LD TMP/SMX is non-inferior to HD TMP/SMX for treatment of Stenotrophomonas pneumonia.
Reference:
Taranto B, Wardlow LC, Coe K, Bazan JA, Leininger J. Low- versus high-dose trimethoprim-sulfamethoxazole for the treatment of Stenotrophomonas maltophilia pneumonia. Antimicrobial Stewardship & Healthcare Epidemiology. 2025;5(1):e95. doi:10.1017/ash.2025.64
