Methods: Chart review of patients admitted at a tertiary medical center over 2 years. Patients were selected from allergy/immunology consult service w/history of allergy to TMP-SMX with need for resistant infection. Several GDE protocols were used w/some modification based on clinical scenario.
Results: 11 patients: age 12-63yo; 9 w/cystic fibrosis (CF), 1 quadriplegia, 1 COPD. Delayed rash reported in 10 patients; 7 w/ pruritus, 2 nausea/vomiting, 1 skin sloughing. Time of reaction to GDE is < 1 year to decades. Some patients received multiple GDEs resulting in 18/19 successful attempts. 1 unsuccessful GDE had repeat fixed drug eruption w/skin sloughing. There were seven 3-step GDEs, dosed at 1/100 then 1/10 then full dose. 3 patients had > 6-step GDE followed by 3-step GDEs thereafter on readmission. Other GDEs varied between 6-30 steps, with intervals of 15min-12hrs between doses.
Conclusions: CF patients are unique w/frequent need for TMP-SMX but are otherwise immunocompetent. We demonstrate safety/efficacy to a variety of GDEs in these immunocompetent patients w/history of TMP-SMX allergy. 1 patient failed without significant morbidity. This suggests that GDEs to TMP-SMX are generally safe/efficacious and 3-step GDEs may be used more often if the clinical scenario so dictates.