Trimethoprim-sulfamethoxazole therapy for Nocardia infections

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Abstract
The optimal therapy for infections due to Nocardia spp. has not been established. To assess the efficacy of trimethoprim-sulfamethoxazole (TMP-SMX), the records of 19 patients with Nocardia infections seen at Duke University Medical Center, Durham, North Carolina [USA], who were treated with this drug, either alone or in combination with other antibiotics or a surgical procedure, were reviewed. Underlying diseases or therapy causing immunosuppression were present in all but 5 cases. Sites of involvement were lung (10 of 19), wound (2 of 19) and brain (2 of 19); 5 of 19 patients had disseminated disease. The mean duration of therapy was 7.2 mo. 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 spp.

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