Am. J. Respir. Crit. Care Med., Vol 151, No. 4, 04 1995, 1068-1074.
Pentamidine aerosol versus trimethoprim-sulfamethoxazole for Pneumocystis carinii in acquired immune deficiency syndrome
AB Montgomery, DW Feigal Jr, F Sattler, GR Mason, A Catanzaro, R Edison, N Markowitz, E Johnson, S Ogawa and M Rovzar
Medical Service, San Francisco General Hospital.
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)
