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Idiopathic pulmonary fibrosis or not: antibiotic prophylaxis for all patients on immunosuppressants
  1. Manuel L Ribeiro Neto1,
  2. Jeffrey J Swigris2,
  3. Daniel A Culver1
  1. 1 The Cleveland Clinic Foundation, Respiratory Institute, Cleveland, Ohio, USA
  2. 2 Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, Denver, Colorado, USA
  1. Correspondence to Dr Manuel L Ribeiro Neto, The Cleveland Clinic Foundation, Respiratory Institute, 9500 Euclid Avenue/A90, Cleveland, OH 44195, USA; ribeirm{at}

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Shulgina et al 1 reported the effects of co-trimoxazole on outcomes in fibrotic idiopathic interstitial pneumonia (IIP). We have some concerns about their conclusions and the emphasis of their findings.

With nearly half (43%) of subjects taking ≥10 mg of prednisolone daily, a dose that increases infection risk,2 and over 30% taking a steroid-sparing agent, a valid alternate explanation for their results is that the beneficial effects of co-trimoxazole were due to prevention of adverse effects of immunosuppressive drugs. The occurrence of fewer pneumonias …

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