Pentamidine aerosol versus trimethoprim-sulfamethoxazole for Pneumocystis carinii
in acquired immune deficiency syndrome.
Author(s): Montgomery AB, Feigal DW Jr, Sattler F, Mason GR, Catanzaro A, Edison R,
Markowitz N, Johnson E, Ogawa S, Rovzar M, et al.
Affiliation(s): Medical Service, San Francisco General Hospital.
Publication date & source: 1995, Am J Respir Crit Care Med. , 151(4):1068-74
Pneumocystis carinii pneumonia remains one of the most common opportunistic
infections in patients with acquired immune deficiency syndrome (AIDS). Treatment
with either intravenous pentamidine or trimethoprim-sulfamethoxazole (TMP-SMX) is
frequently complicated by serious adverse reactions. This study was a
prospective, blinded comparison of 600 mg/d of pentamidine as an aerosol versus
15 mg/kg/d of trimethoprim plus 75 mg/kg/d of sulfamethoxazole for patients with
mild or moderately severe P. carinii pneumonia (alveolar arterial oxygen
difference of less than 55 mm Hg). Of 367 participants who were randomized to
receive study therapies, 287 had proven and 16 had presumed Pneumocystis
pneumonia. There were 29 deaths within 35 d of study initiation: 12 in the
aerosolized pentamidine group and 17 in the TMP-SMX groups (log rank p = 0.28).
The difference in mortality was 3.4% (95% CI = -3.5, 10.8%). Ninety-four patients
treated with aerosolized pentamidine had to have their study therapy changed
because of lack of efficacy, compared with 22 patients treated with TMP-SMX (p =
0.002). In addition PaO2 improved faster in patients treated with TMP-SMX.
However, aerosolized pentamidine was discontinued less often than TMP-SMX because
of toxicity (9.4 versus 40% p < 0.001). Rash (0.6 versus 14.9%), nausea and
vomiting (1.7 versus 12.2%), and abnormalities of liver function tests (1.7
versus 12.2%) were the most common adverse effects necessitating treatment
discontinuation. During 6-mo. follow-up there was no difference in
mortality.(ABSTRACT TRUNCATED AT 250 WORDS)
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