EFFECT OF CORTICOSTEROIDS ON THE INCIDENCE OF ADVERSE CUTANEOUS REACTIONS TO TRIMETHOPRIM-SULFAMETHOXAZOLE DURING TREATMENT OF AIDS-ASSOCIATED PNEUMOCYSTIS-CARINII PNEUMONIA

We retrospectively studied all courses of treatment with trimethoprim- sulfamethoxazole (TMP-SMZ) alone and with adjuvant corticosteroids for AIDS-associated Pneumocystis carinii pneumonia. The corticosteroids w ere administered for 8-21 days (mean, 14 days) because of hypoxemia. W e evaluated the influence of corticosteroids on the incidence of cutan eous adverse reactions to TMP-SMZ and on the course of AIDS during 3 m onths of follow-up. Of 38 patients treated with TMP-SMZ alone, 18 (47% ) developed cutaneous side effects, whereas three (13%) of the 23 pati ents who received adjuvant corticosteroid therapy experienced such eff ects (P = .014). Of the 21 reactive patients, 14 were treated througho ut the duration of hypersensitivity. Therapy was interrupted for seven patients (18%) treated with TMP-SMZ alone and for none of those who w ere given adjuvant corticosteroid therapy (P =.23). During follow-up, the incidence of mucocutaneous herpes simplex virus infection was high er among patients who received adjuvant corticosteroids than among tho se treated with TMP-SMZ alone (P = .005). Adjuvant corticosteroids thu s reduce the incidence of adverse cutaneous reactions to TMP-SMZ in pa tients with AIDS who are treated for hypoxemic P. carinii pneumonia.