Pentamidine aerosol to prevent Pneumocystis carinii pneumonia

Article Abstract:

Pneumocystis carinii pneumonia (PCP) occurs in almost 80 percent of patients with the acquired immune deficiency syndrome (AIDS), and often results in disease and death. Most agents used to treat PCP have serious adverse side effects. Recently an aerosol form of pentamidine isethionate was approved for treating PCP. This infection occurs in AIDS patients when their T helper cells, a type of immune cell, decrease to less than 20 percent of the total number of lymphocytes, a type of white blood cell. The risk of PCP recurrence is as high as 60 percent. Aerosolized pentamidine was shown to decrease the recurrence rate of PCP in AIDS patients. Adverse effects of aerosolized pentamidine include coughing and, to a lesser extent, wheezing which occurs most often in smokers and patients with asthma. These effects can be avoided by use of a bronchodilator, an agent that dilates the bronchi, the muscular passages from the upper respiratory tract to the lungs. Other toxic effects of aerosolized pentamidine include pancreatitis, or inflammation of the pancreas, and skin disorders. The coughing associated with the use of the pentamidine aerosol led to transmission of the microorganism that causes tuberculosis. Spreading of Pneumocystis infection to body sites other than the lung have also been reported in patients using the aerosol. The dosage of aerosolized pentamidine is described. Aerosolized pentamidine, given once a month, prevents PCP in AIDS patients, and causes fewer side effects than drugs given directly into the circulation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Aerosol therapy

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Intravenous or inhaled pentamidine for treating Pneumocystis carinii pneumonia in AIDS: a randomized trial

Article Abstract:

Patients with acquired immunodeficiency syndrome (AIDS) are susceptible to a form of pneumonia resulting from infection with the organism Pneumocystis carinii. Treatment with intravenous pentamidine has been successful and a study was conducted comparing the effectiveness of reduced-dose pentamidine given intravenously and pentamidine by inhalation in these patients. Seventeen patients received aerosolized pentamidine and 22 patients received intravenous pentamidine. Although inhaled pentamidine is less toxic than the same drug given intravenously, treatment failures, return of symptoms, and a relapse rate of 24 percent occurred, leading to early termination of the study. Previously reported success rates have been variable, with a low of less than 20 percent and a high of 80 percent. The failure and relapse rates in this study with aerosolized pentamidine were considered unacceptably high; reduced-dose pentamidine, however, is considered an effective treatment for mild to moderate P. carinii pneumonia in AIDS patients. The rate of major toxicities from lower doses of intravenous therapy in this study was reduced 14 percent and thus low dose pentamidine is considered acceptable therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Lungs, Lung, Dosage and administration

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Atovaquone for Pneumocystis carinii pneumonia

Article Abstract:

Oral atovaquone may be an effective and safe treatment for mild to moderate Pneumocystis carinii pneumonia (PCP) in patients who cannot be treated with trimethoprim-sulfamethoxazole. PCP is a common opportunistic infection in AIDS patients. Some AIDS patients may develop side effects during treatment with trimethoprim-sulfamethoxazole, the drug most commonly used to treat PCP. Atovaquone interferes with the metabolism of Pneumocystis carinii, the protozoan that causes PCP. It also interferes with the metabolism of the microorganisms that cause malaria and toxoplasmosis. A research study found that oral atovaquone may be less effective than trimethoprim-sulfamethoxazole for the treatment of PCP. The development of a rash is the most common side effect experienced by patients treated with atovaquone.

Mepron (Medication)

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