Co-trimoxazole 80mg/400mg/5ml solution for infusion ampoules

BackgroundCo-trimoxazole is used as a prophylaxis for human immunodeficiency virus (HIV) patients to prevent opportunistic infections. Its widespread use results in the emergence of co-trimoxazole resistance, which is a significant problem. This systematic review and meta-analysis determined the pooled prevalence of co-trimoxazole resistance among HIV-infected individuals in Ethiopia.MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was applied to report this study. The protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the assigned number CRD42024532240. Article search was performed using electronic databases such as PubMed, Medline, EMBASE, Google Scholar, Hinari, Web of Science, Science Direct, and African Journals Online. Data were extracted using a Microsoft Excel spreadsheet and analyzed using STATA version 11.0 software. A random-effects model was used to estimate the pooled effect size of co-trimoxazole resistance across studies with a 95% confidence interval. The heterogeneity was checked using I2 statistic. The presence of publication bias was determined using a funnel plot and Egger's test with a p-value ResultsTwenty-two studies with 5,788 HIV-infected individuals were included. The pooled prevalence of co-trimoxazole resistance was 61.73% (95% CI: 53.10-70.37%), with heterogeneity (I2 = 87.7%) and statistical significance (p Escherichia coli; 70.86% (95% CI: 53.44-88.27%) followed by Salmonella spp.; 67.66% (95% CI: 41.51-93.81%) and Proteus spp.; 66.23% (95% CI: 34.65-97.82%).ConclusionThere is a higher prevalence of co-trimoxazole resistance in HIV-infected individuals in Ethiopia. This alarms WHO's recommendation of co-trimoxazole prophylaxis guidelines to review and update it. Additionally, a nationwide assessment of co-trimoxazole resistance in Ethiopia as a whole is required.Systematic review registration: identifier: CRD42024532240.

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Abstract Background: South Asia and Sub-Saharan Africa account for about 90% of all diarrheal fatalities in children worldwide. The World Health Organization guideline suggests the use of co-trimoxazole in the management of bloody diarrhea, cholera, and invasive bacterial diarrhea in children. However, there are reports on the inappropriate and empirical use of co-trimoxazole for the management of diarrhea in Ethiopia. Our objective was to estimate the prevalence of bacterial resistance against co-trimoxazole from stool isolates of diarrheic children in Ethiopia and to identify the factors associated with it. Methods:We conducted a comprehensive database search in PubMed and Embase electronic databases to retrieve studies published between 2000 and 2021. We assessed heterogeneity across studies using Higgin's I² test statistic and Cochrane Q test. We used a random-effects model to pool the proportion of bacterial resistance. We evaluated publication bias using a funnel plot and Egger's regression test. The Joanna Briggs Institute (JBI) critical appraisal tool was used to measure the quality of the papers included. Results: We included 20 eligible studies (1040 isolates) reporting the antimicrobial resistance of Shigella, Salmonella, E.coli,and Campylobacter against co-trimoxazole. The pooled proportion of co-trimoxazole resistance to the four diarrheagenic enteropathogens was 50.3 % with (95%CI: 41.7%-58.8%). We carried out a subgroup analysis based on four factors; bacterial species, participants’ age, region, study setting and sample size. The highest resistance was E. coli, 62.3 % (95%CI; 38%-83%) followed by Shigella 51.4% (95%CI; 38%-64%). There was a significant difference in the co-trimoxazole resistance of studies that had a sample size above 250 participants (58.5%) versus studies having a sample size below 250 (34.2%). However, there was no significant difference in co-trimoxazole resistance between children aged below 5 years compared with children above 5 years. Conclusion: Bacterial isolates from the stool of diarrheic Ethiopian children have shown resistance to co-trimoxazole. E. coli showed the highest resistance among the isolates. Therefore, we need to exercise caution in the over-the-counter use of co-trimoxazole and promote the rational use and prescribing practice of co-trimoxazole by healthcare providers. Prevention interventions such as safe drinking water, improved sanitation, and handwashing with soap can reduce disease risk and the use of antibiotic use. Additionally, breastfeeding and rotavirus vaccination can also reduce the incidence of acute gastroenteritis in young children. Systematic review registration PROSPERO CRD42023281838.

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Urinary tract infections (UTIs) are one of the most important infectious complications in kidney transplant recipients; hence, antibiotic prophylaxis is warranted. Due to limited information for selection of an appropriate antibiotic for prophylaxis, as well as the varying reports concerning increasing resistance of Escherichia coli as the common related pathogen, this systematic review and meta-analysis assess the effect of a combined regimen including fluoroquinolone + co-trimoxazole as prophylaxis in high-risk group patients. PubMed, Cochrane Library, Embase, and Web of Science were used as electronic databases to perform a systematic literature between 2010 and December 2024. A commercially available software program (EndNote X9) was used for electronic title management. Searches were performed with keywords, ("Urinary Tract Infections" OR "urinary tract infection" OR "UTI") AND ("Kidney Transplantation" OR "renal transplant*" OR "kidney transplant*") AND ("Co-Trimoxazole" OR "co-trimoxazole" OR "trimethoprim sulfamethoxazole" OR "TMP-SMX") AND ("Fluoroquinolones" OR "fluoroquinolone*" OR "ciprofloxacin" OR "levofloxacin"). A total of 454 potentially relevant titles and abstracts were found during the electronic and manual search, finally two studies were included. Heterogeneity showed a higher percentage of patients in Group I suffered from urinary infection, compared to Group II. Addition of ciprofloxacin to the standard regimen, co-trimoxazole, was related to a reduced risk of UTI in kidney transplant recipients.

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