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Jose G. Montoya, Jack S. Remington, Reply, Clinical Infectious Diseases, Volume 36, Issue 7, 1 April 2003, Page 933, https://doi.org/10.1086/368213
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Sir—We thank Muñoz et al. [1] for their correspondence regarding our article on infectious complications among heart transplant patients at Stanford University Medical Center (Stanford, CA) [2]. Dr. Muñoz and colleagues acknowledge that there are few published data to support the use of trimethoprim-sulfamethoxazole (TMP-SMZ) alone for the prevention of toxoplasmosis in heart transplant recipients. However, their data, along with findings on the use of TMP-SMZ for prophylaxis and treatment of toxoplasmosis in HIV-positive patients, are compelling.
We agree that the use of TMP-SMZ alone may be sufficient to prevent toxoplasmosis in patients who are seronegative for Toxoplasma gondii IgG antibodies and who receive a heart transplant from donors seropositive for T. gondii IgG antibodies (i.e., D+/R- patients). The optimal schedule of administration of TMP-SMZ to this group of patients is less clear and requires further study. Until these studies are performed, physicians must decide whether a schedule of daily administration or administration 3 times a week is to be used. For HIV-infected patients, we routinely recommend daily use of TMP-SMZ whenever feasible [3].
