Life-Threatening Reaction to Trimethoprim/Sulfamethoxazole in Pediatric Human Immunodeficiency Virus Infection

Trimethoprim/sulfamethoxazole (TMP/SMX) is frequently administered to children with human immunodeficiency virus (HIV) infection for treatment or prevention of bacterial and opportunistic infections.1 The incidence of adverse reactions to this drug combination in HIV-infected individuals seems to be higher than in those without HIV infection.2-6 Severe life-threatening reactions to TMP/SMX are rare and have been reported in adult patients with and without HIV infection. Two HIV-infected children with life-threatening reactions after rechallenge with TMP/SMX are described. In each case, the patient survived, but only after intensive care management. With the expected increase in the number of HIV-infected children and the need to administer prophylaxis against Pneumocystis carinii pneumonia, pediatric care providers should be aware of this dangerous, adverse reaction to TMP/ SMX.