Sulfonamides are recommended as part of first-line therapy for most Nocardia infections, 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 serious Nocardia infections, 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 a Nocardia infection 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 of Nocardia infections with sulfonamide regimens not containing trimethoprim in transplant recipients and other immunocompromised hosts.
Keywords: Nocardia; immunocompromised; sulfadiazine; sulfisoxazole; sulfonamide; transplant; trimethoprim.
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