Cost and benefit of secondary prophylaxis for Pneumocystis carinii pneumonia

Article Abstract:

Pneumonia resulting from infection with Pneumocystis carinii is one of the opportunistic infections which plagues patients with AIDS. Over 80 percent of all AIDS patients will develop this infection at some point, and for 20 percent it is likely to be fatal. Therefore, all AIDS patients should be given some sort of antibiotic treatment to prevent this infection. Many physicians prescribe prophylactic treatment with pentamidine for this purpose. The drug combination trimethoprim and sulfamethoxazole is less expensive than pentamidine and is also effective. However, this drug combination sometimes produces toxic side effects in some patients, leading many physicians to begin with and stay with the more expensive pentamidine. No studies have been conducted to directly compared these two prophylactic treatments, and therefore the practicing physician has no data on which to base an informed decision. However, researchers have now developed a mathematical model to evaluate the likely results of adopting different methods of prophylaxis. Data on infection rates and side effects from different treatment were gleaned from the medical literature and incorporated into a statistical model called a Markov model. The analysis of this model then provided the likely results of different treatment schemes without those schemes actually being tried on experimental subjects. This analysis showed that if patients were routinely treated with the combination of trimethoprim and sulfamethoxazole and given pentamidine only if toxic effects developed, then the cost of treatment would be an average of $2,094 per patient less than if patients were routinely started on pentamidine. Furthermore, this savings is achieved at no cost in decreased survival. Indeed, the mathematical model predicted that AIDS patients started on trimethoprim and sulfamethoxazole would survive an average of about 24 days longer than patients started on pentamidine. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Economic aspects, AIDS (Disease), Combination drug therapy, Trimethoprim, Pentamidine isethionate, Pentamidine, Co-trifamole

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Recommendations for prophylaxis against Pneumocystis carinii pneumonia for adults and adolescents infected with HIV

Article Abstract:

Adults and adolescents infected with HIV who are at high risk for developing Pneumocystis carinii pneumonia (PCP) should be treated with drugs to prevent PCP. The US Public Health Service established a task force in 1989 to study preventive treatment for PCP in HIV-infected individuals. The task force found that the risk of illness and death and the cost of treatment for HIV-infected individuals could be reduced by preventative treatment for PCP. Before preventative treatment for PCP began, most AIDS patients developed PCP at least once. Patients with low levels of T-lymphocytes, or cells of the immune system, and those who have had PCP, should be treated with oral doses of trimethoprim-sulfamethoxazole (TMP-SMX) or with aerosol pentamidine. TMP-SMX may be more effective and less expensive than aerosol pentamidine. Patients receiving preventative treatment should be monitored closely for Pneumocystis carinii infections. Patients receiving preventative treatment who develop PCP should be treated with a higher dose, or with a different drug. Children infected with HIV should also be treated with TMP-SMX.

Complications and side effects, HIV infection, HIV infections

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Multidrug-resistant tuberculosis

Article Abstract:

The multidrug-resistant tuberculosis (MDR-TB), defined as resistance to isoniazid and rifampin, has declined in the United States. However, the multidrug-resistant strains of Mycobacterium tuberculosis are particularly problematic in developing countries since alternative agents like pyrazinamide, ethambutol and the quinolones are less effective, more expensive and less well-tolerated than their more standard counterparts such as isoniazid and rifampin.

United States, Usage, Drug therapy, Tuberculosis, Isoniazid, Rifampin

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