International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2026
Impact of prolonged co-trimoxazole prophylaxis on colonisation with antibiotic resistant bacteria in persons newly diagnosed with HIV-infection: CoTrimResist - a randomised placebo-controlled trial.
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Blomberg Bjørn, Manyahi Joel, Moyo Sabrina, Tellevik Marit, Aboud Said, Kuwelker Kanika, Sandnes Helene Heitmann, Lie Rolv Terje, Langeland Nina
Аннотация
OBJECTIVE: To assess whether prolonged co-trimoxazole prophylaxis for people with HIV in sub-Saharan Africa increases colonisation with antibiotic-resistant bacteria.
METHODS: The CoTrimResist trial (NCT03087890) randomised newly diagnosed Tanzanian adults with HIV and CD4 counts >350/µL to daily co-trimoxazole or placebo for one year. Clinical data, rectal and nasopharyngeal/nasal swabs were collected at enrolment, two weeks, six months, and one year. Primary outcomes were carriage of extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC) and Klebsiella species (ESBL-K), methicillin-resistant Staphylococcus aureus (MRSA), and penicillin-non-susceptible pneumococci (PNSP).
FINDINGS: Among 537 participants (median age 37 years; 77% female), 259 received co-trimoxazole and 278 placebo. Co-trimoxazole temporarily reduced nasal S. aureus carriage at two weeks (risk difference -7.3%; 95% CI -12.0% to -2.6%) and six months (-7.6%; 95% CI -13.9% to -1.3%), and MRSA at two weeks (-4.5%; 95% CI -8.0% to -1.1%). ESBL-EC colonisation increased more rapidly with co-trimoxazole. At one year, there were no between-group differences in colonisation rates, mortality or serious adverse events. Intercurrent use of other antibiotics was associated with increased carriage of ESBL-EC.
CONCLUSIONS: Prolonged co-trimoxazole prophylaxis leads to transient reductions in S. aureus and MRSA and early increase in ESBL-EC, but shows no persistent effect on colonisation with antimicrobial-resistant bacteria at one year.
METHODS: The CoTrimResist trial (NCT03087890) randomised newly diagnosed Tanzanian adults with HIV and CD4 counts >350/µL to daily co-trimoxazole or placebo for one year. Clinical data, rectal and nasopharyngeal/nasal swabs were collected at enrolment, two weeks, six months, and one year. Primary outcomes were carriage of extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC) and Klebsiella species (ESBL-K), methicillin-resistant Staphylococcus aureus (MRSA), and penicillin-non-susceptible pneumococci (PNSP).
FINDINGS: Among 537 participants (median age 37 years; 77% female), 259 received co-trimoxazole and 278 placebo. Co-trimoxazole temporarily reduced nasal S. aureus carriage at two weeks (risk difference -7.3%; 95% CI -12.0% to -2.6%) and six months (-7.6%; 95% CI -13.9% to -1.3%), and MRSA at two weeks (-4.5%; 95% CI -8.0% to -1.1%). ESBL-EC colonisation increased more rapidly with co-trimoxazole. At one year, there were no between-group differences in colonisation rates, mortality or serious adverse events. Intercurrent use of other antibiotics was associated with increased carriage of ESBL-EC.
CONCLUSIONS: Prolonged co-trimoxazole prophylaxis leads to transient reductions in S. aureus and MRSA and early increase in ESBL-EC, but shows no persistent effect on colonisation with antimicrobial-resistant bacteria at one year.