Pleural effusion and renal cell carcinoma: an angiographic-pathologic correlation.

We are indeed encouraged to learn of the successful use of trimethoprim and sulfamethoxazole in combination with other antimicrobial agents for treating disseminated melioidosis, as reported by Tanphaichitra and coauthors In our single experience with life-threatening disease limited to the lungs (Chest 74:222-224, 1978), antagonism occurred when trixnethoprim and sulfamethoxazole were used in various combinations with tetracycline, chloramphenicol, and kanamycin. This antagonism, which was suspected because of the failure of the patient’s condition to improve clinically, was confirmed by studies of the serum showing an absence of bactericidal activity; however, bactericidal activity was excellent when the combination of trimethoprim and sulfamethoxazole was used alone in high dosage. Although no significant antagonism occurred in the cases of Tanphaichitra et al, it would have been interesting to know the serum bactericidal levels of the combinations of drugs vs that of the trimethoprim-sulfamethoxazole combination used alone at high dosage. If the combination of trimethoprion and sulfamethoxazole alone could be used in disseminated melioidosis, it would avoid the well-known potential side effects of therapy with the other antibiotics. We continue to recommend determining serum bactericidal levels in serious cases of melioidosis. These levels are rapidly obtained from the bacteriology services of most