Aerosolized pentamidine for prophylaxis against Pneumocystis carinii pneumonia: the San Francisco Community Prophylaxis Trial

Article Abstract:

The most frequent cause of death among patients infected with HIV (human immunodeficiency virus, the agent associated with AIDS) is Pneumocystis carinii pneumonia (PCP). Although certain drugs prevent this disease in some AIDS patients and individuals whose immune systems are compromised by other disorders, HIV-infected people cannot tolerate these medications on a long-term basis. An agent that shows promise in this regard is aerosolized pentamidine; a report of a controlled, randomized trial of this drug is presented. Three dosages of aerosolized pentamidine (30 milligrams every two weeks, 150 milligrams every two weeks, or 300 milligrams every four weeks) were administered to 408 patients at 12 treatment centers in the San Francisco Bay area. The majority of patients (237) had one prior episode of PCP; other groups included patients with Kaposi's sarcoma (an AIDS-related condition) who had never had PCP (55), and patients with AIDS or AIDS-related complex who had never had PCP or Kaposi's sarcoma (116). Patients were followed from their first treatment on or near July 1, 1987 until their death or December 31, 1988. The results revealed that the number of PCP episodes was lowest for patients who received the 300 milligram dose of aerosolized pentamidine (8 episodes), and that this number differed significantly from the number of PCP episodes among patients who were given the 30 milligram dose (22 episodes). Although the difference between the 150 milligram and 300 milligram doses was not significant, the lower dose was less effective when compared with the 30 milligram dose of aerosolized pentamidine. Patients who began the study within three months of a previous episode of PCP had less chance of having another episode than those who started later. Participants who had never taken zidovudine (a drug for treating AIDS) had higher mortality than those who had taken it, and zidovudine itself had an independent preventive effect on PCP. Those with a previous history of PCP and CD4 cell counts (a type of T cell) below 200 per cubic millimeter had the highest risk of contracting PCP again. Overall, aerosolized pentamidine at certain doses was an effective prophylactic treatment for preventing PCP in high-risk HIV-infected people. The most effective therapeutic regimen included zidovudine. (Consumer Summary produced by Reliance Medical Information, Inc.)

Dosage and administration, Aerosol therapy

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A controlled trial of aerosolized pentamidine or trimethoprim-sulfamethoxazole as primary prophylaxis against Pneumocystis carinii pneumonia in patients with human immunodeficiency virus infection

Article Abstract:

Trimethoprim-sulfamethoxazole may be more effective than aerosolized pentamidine for preventing Pneumocystis carinii pneumonia (PCP) in HIV-infected individuals. PCP is a common opportunistic infection among individuals infected with HIV. Among 213 HIV-infected patients with low levels of T-cells and no previous episodes of PCP, 71 were treated with 480 milligrams (mg) of trimethoprim-sulfamethoxazole per day, 71 were treated with 960 mg of trimethoprim-sulfamethoxazole per day and 71 were treated with 300 mg of aerosolized pentamidine once a month. None of the patients treated with trimethoprim-sulfamethoxazole developed a first episode of PCP during an average follow-up period of 264 days, compared with six (11%) of the patients treated with pentamidine. Patients in both trimethoprim-sulfamethoxazole treatment groups were more likely to experience severe side effects than those in the pentamidine group.

Usage, Co-trimoxazole, Trimethoprim-sulfamethoxazole (Drug combination)

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Dapsone-pyrimethamine compared with aerosolized pentamidine as primary prophylaxis against Pneumocystis carinii pneumonia and toxoplasmosis in HIV infection

Article Abstract:

Combining dapsone with pyrimethamine appears to be as effective as aerosolized pentamidine in preventing Pneumocystis (P.) carinii pneumonia among patients infected with HIV. Of 349 HIV patients, 176 were treated with aerosolized pentamidine and 173 took dapsone and pyrimethamine. During follow-up, 10 (5.7%) of the patients treated with pentamidine developed P. carinii pneumonia compared with 10 (5.8%) of the patients who took dapsone and pyrimethamine. Toxoplasmosis, which is an infection by the protozoan Toxoplasma gondii affecting many HIV-positive patients, developed in 32 patients (18.2%) who were treated with pentamidine and in 19 (11%) who took dapsone and pyrimethamine. Therapy had to be interrupted because of drug-related side effects in 42 of the patients who took dapsone and pyrimethamine but only in three of the patients who took pentamidine.

Dapsone, Toxoplasmosis, Pyrimethamine

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