A Controlled Trial of Trimethoprim–Sulfamethoxazole or Aerosolized Pentamidine for Secondary Prophylaxis of Pneumocystis carinii Pneumonia in Patients with the Acquired Immunodeficiency Syndrome

Abstract

In patients with AIDS who are receiving zidovudine, trimethoprim-sulfamethoxazole is more effective than aerosolized pentamidine in conventional doses for the prevention of recurrent pneumocystis infection.

Intermittent oral trimethoprim/sulfamethoxazole on two non‐consecutive days per week is effective as Pneumocystis jiroveci pneumonia prophylaxis in pediatric patients receiving chemotherapy or hematopoietic stem cell transplantation

“…TMP-SMZ is the most effective drug for PCP prophylaxis [2,[8][9][10]. TMP inhibits dihydrofolate reductase and SMZ inhibits dihydropteroate synthetase.…”

Once-Weekly Administration of Dapsone/Pyrimethamine vs. Aerosolized Pentamidine as Combined Prophylaxis for Pneumocystis carinii Pneumonia and Toxoplasmic Encephalitis in Human Immunodeficiency Virus-Infected Patients

“…In addition, new data suggested that dapsone/ pyrimethamine [ 10] and possibly trimethoprim-sulfamethoxazole [24] prevent toxoplasmosis. Meanwhile, administration of trimethoprim-sulfamethoxazole became the standard prophylaxis for PCP [5,6,25], and continuing the prophylactic administration of aerosolized pentamidine to patients who were seropositive for toxoplasmosis seemed unethical. The trial was therefore stopped prematurely as of 31 December 1992.…”

“…Prophylaxis with trimethoprim-sulfamethoxazole also appears to protect against toxoplasmic encephalitis, but the optimal dose is unknown and the assessments of efficacy have been based only on a retrospective analysis [24], observational data [34,35], or results of controlled trials that did not primarily target prophylaxis for toxoplasmic encephalitis and therefore yielded small numbers of events [5,6,31,[36][37][38]. While none of these trials revealed a significant protective effect on an intent-to-treat basis, toxoplasmic encephalitis in fact rarely occurred during treatment with trimethoprim-sulfamethoxazole.…”

“…For PCP prophylaxis, trimethoprim-sulfamethoxazole is more effective than aerosolized pentamidine [5,6], and it became the first-line prophylactic agent in 1992 [25]. Weekly doses of 3-7 double-strength tablets of trimethoprim-sulfamethoxazole appear equally effective [ Oral dapsone is an alternative prophylactic agent for PCP, although it may be slightly less effective than trimethoprimsulfamethoxazole.…”

“…Aerosolized pentamidine became available in Switzerland in 1987 and was subsequently proven effective for both primary and secondary prophylaxis for PCP in controlled trials [2,3]. Among systemic prophylactic agents, trimethoprim-sulfamethoxazole became widely used [4] and was later shown to be more effective but also more toxic than aerosolized pentamidine [5,6] nations, such as dapsone and trimethoprim [7] or pyrimethamine and sulfadiazine [8], have been used for treatment of PCP before, but sparse data exist concerning their prophylactic efficacy [9]. Only recently, the prophylactic efficacy of the combination of dapsone and pyrimethamine against PCP and toxoplasmosis was demonstrated [ 10].…”