Sulfonamides without trimethoprim in the treatment ofNocardiainfections: A case report and literature review

Sulfonamides are recommended as part of first-line therapy for mostNocardiainfections, with trimethoprim-sulfamethoxazole (TMP-SMX) considered the drug of choice for susceptible isolates. However, in the case of central nervous system, disseminated disease, and other seriousNocardiainfections, TMP-SMX should not be used as monotherapy. The preferred treatment for a patient unable to take TMP-SMX because of allergy or intolerance remains uncertain. Prior to the availability of TMP-SMX in 1973, other sulfonamides were mainstays of treatment. We describe aNocardiainfection successfully treated with sulfadiazine in a lung transplant recipient who could not tolerate TMP-SMX. A review of similar cases reported in the literature provides insight into the successful treatment ofNocardiainfections with sulfonamide regimens not containing trimethoprim in transplant recipients and other immunocompromised hosts.