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News
A new trial finds that daily co-trimoxazole in adults with newly diagnosed HIV briefly reduced carriage of S. aureus and MRSA, but those gains faded within a year. The antibiotic had no meaningful impact on other resistant bacteria or on survival outcomes. Researchers say the findings raise questions about the long-term value of extended prophylaxis in immunocompetent HIV patients.
A randomized controlled trial out of Tanzania found that daily co-trimoxazole prophylaxis in adults with newly diagnosed HIV produced only short-lived reductions in antibiotic-resistant bacteria carriage — and those benefits didn't last. While the drug temporarily lowered S. aureus and MRSA nasal carriage at 2 weeks and 6 months, both had rebounded to placebo-level rates by the 1-year mark.
The trial enrolled 537 adults across six sites in Dar es Salaam, tracking colonization of resistant bacteria in the gut, nose, and throat. Beyond the temporary MRSA and S. aureus reductions, co-trimoxazole showed no significant effect on pneumococcal colonization or ESBL-producing bacteria — and ESBL-EC colonization actually doubled in the co-trimoxazole group over the year.
By the Numbers:
Why it matters: With antimicrobial resistance (AMR) a growing global crisis, this study adds important nuance to WHO guidelines supporting prolonged co-trimoxazole prophylaxis in HIV patients — suggesting that in immunocompetent individuals, the long-term AMR benefit may be limited at best.
