Corticosteroids as adjunctive therapy for severe Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome: a double-blind, placebo-controlled trial

Article Abstract:

Pneumocystis carinii (PC) pneumonia is one of the hallmarks of AIDS; for 60 to 65 percent of AIDS patients, the diagnosis of PC pneumonia leads to the diagnosis of AIDS, and 80 to 85 percent have PC pneumonia at some time. The mortality rate of Pneumocystis carinii pneumonia is 25 percent. There has been some indication that, in addition to antibiotic treatment, the use of corticosteroids may provide some benefit for AIDS patients with PC pneumonia. For this reason, a placebo-controlled study was designed to confirm if this was indeed the case. Before the study was completed, the use of corticosteroids was, in fact, found to be so beneficial that ethics demanded the study be cancelled so that no patient would be deprived of the treatment. Although researchers had anticipated enrolling 80 patients, only 23 actually participated; the study was terminated when statistical significance was achieved. All patients were treated with the antibiotic combination trimethoprim-sulfamethoxazole. Twelve patients also received corticosteroids. Nine of the patients who received corticosteroids as adjunctive therapy were discharged from the hospital, compared with only 2 of the 11 patients who received antibiotics alone. Nine of the 11 patients who were not treated with corticosteroids developed respiratory failure, in contrast with only 3 of the 12 corticosteroid-treated patients. There were no acute side effects that required discontinuing the corticosteroids. However, these agents may increase the likelihood of some other complications of AIDS, such as mycobacterial infection and Kaposi's sarcoma. The high mortality among the patients who received only antibiotics prevented any evaluation of this possibility. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Patient outcomes, Mortality, Drug therapy, Corticosteroids, Adrenocortical hormones, Methylprednisolone, Opportunistic infections, Pneumocystis carinii

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Comparison of atovaquone (566C80) with trimethoprim-sulfamethoxazole to treat Pneumocystis carinii pneumonia in patients with AIDS

Article Abstract:

Atovaquone appears to be less effective but better tolerated than trimethoprim-sulfamethoxazole in treating Pneumocystis (P.) carinii pneumonia in patients with AIDS. Of 284 AIDS patients with P. carinii pneumonia, 138 took atovaquone and 146 took trimethoprim-sulfamethoxazole. Twenty-eight (20%) of the patients who took atovaquone did not respond to therapy compared with 10 (7%) who took trimethoprim-sulfamethoxazole. Of 322 AIDS patients with P. carinii pneumonia, 44% of those who took trimethoprim-sulfamethoxazole reported nausea, 35% reported vomiting, 17% reported constipation, 25% reported fever and 34% reported a rash. However, among those who took atovaquone, 20% reported nausea, 14% reported vomiting, 3% reported constipation, 14% reported fever and 23% reported a rash.

Evaluation, Prevention, Co-trimoxazole, Trimethoprim-sulfamethoxazole (Drug combination)

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Similar abstracts:

• Abstracts: Pneumocystis carinii pneumonia: the steroid dilemma. Steroids for Pneumocystis carinii pneumonia and respiratory failure in the acquired immunodeficiency syndrome: a reassessment
• Abstracts: Low-dose intermittent trimethoprim-sulfamethoxazole for prevention of Pneumocystis carinii pneumonia in patients with human immunodeficiency virus
• Abstracts: Aerosolized pentamidine for prophylaxis against Pneumocystis carinii pneumonia: the San Francisco Community Prophylaxis Trial

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