RESULTS FROM RECENT THERAPEUTIC TRIALS FOR OPPORTUNISTIC INFECTIONS (Ols) FROM THE UNITED STATES

Hardy, William; Bozzette, Sam; Safrin, Sharon; Black, J. Harvey; Farthing, Charles; Saag, Michael S.

doi:10.1097/00002030-199411004-00059

Cited by 8 publications

(3 citation statements)

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“…Dapsone with trimethoprim is useful for treating patients with mild or moderately severe PCP who cannot tolerate co-trimoxazole. The recently published AIDS Clinical Trials Group Study 108, comparing oral regimens of co-trimoxazole 1920 mg tds, dapsone 100 mg od and trimethoprim 300 mg tds or clindamycin 600 mg tds and primaquine 30 mg od, showed no differences in either time to treatment failure, the overall treatment failure rate (all were < 10%) or the frequency of dose-limiting toxicity (24-36%) (Hardy et al, 1994).…”

Section: Dapsone With Trimethoprimmentioning

confidence: 98%

“…This drug combination was originally used as 'salvage' therapy for patients with mild to moderately severe PCP who were failing to respond to treatment with co-trimoxazole or pentamidine (Toma et al, 1989); clindamycin was given intravenously. More recent trials have shown the drugs to be effective when given orally (Hardy et al, 1994;Black, Feinberg & Murphy, 1994). Approximately 60% of patients develop a rash.…”

Section: Clindamycin and Primaquinementioning

confidence: 99%

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Pneumocystis carinii infection: current treatment and prevention

Miller

Noury

Corbett

et al. 1996

Journal of Antimicrobial Chemotherapy

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Pneumocystis carinii is a common cause of pneumonia in individuals who are immunosuppressed by HIV infection. Use of molecular biological techniques show that P. carinii is a fungus and that infection in man is not a zoonosis. Invasive tests such as sputum induction or bronchoscopy are used to make the diagnosis of P. carinii pneumonia. Life long primary prophylaxis is given to HIV positive individuals with CD4+ lymphocyte counts < 0.20 x 10(9)/L or a CD4: total lymphocyte ratio of < 1.5, constitutional symptoms, or with other AIDS defining diseases. Secondary prophylaxis is given after a first episode to prevent a recurrence. First choice for primary and secondary prophylaxis is oral co-trimoxazole 960 mg od or three times a week. In patients who are intolerant to co-trimoxazole, nebulised pentamidine or dapsone (with or without pyrimethamine) are second and third choices. In a patient with acute PCP disease, severity should be assessed using clinical, radiographic and blood gas criteria as those with moderate or severe disease will benefit from adjuvant glucocorticoids. Co-trimoxazole (120 mg/kg/day in divided doses for 21 days) is first choice therapy for PCP of all degrees of severity. In patients who fail to respond to co-trimoxazole or who are intolerant to it, second line treatment is iv pentamidine in those with severe disease and oral dapsone with trimethoprim, oral clindamycin with primaquine or iv pentamidine in those with mild or moderately severe disease.

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Section: Dapsone With Trimethoprimmentioning

confidence: 98%

Section: Clindamycin and Primaquinementioning

confidence: 99%

Pneumocystis carinii infection: current treatment and prevention

Miller

Noury

Corbett

et al. 1996

Journal of Antimicrobial Chemotherapy

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“…Azithromycin in combination with pyrimethamine has been shown to be active against Toxoplasma gondii [135] and one report suggests that this combination may be a second-line alternative to pyrimethamine plus sulfadrazine for treating T. gondii encephalitis [136].…”

Section: Other Organisms/infectionsmentioning

confidence: 99%

The macrolides

Hansen

Metzler

DeCarolis

et al. 2002

Expert Opinion on Investigational Drugs

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Erythromycin, which was introduced over 50 years ago, was the first macrolide to be used clinically. "New" macrolides, for the treatment of patients with various infectious diseases, were not clinically introduced until 40 years later. The pharmacokinetic and adverse events profile of erythromycin initially limited its use to an alternative agent for patients with allergy to beta-lactam agents. However, the emergence of atypical and/or new pathogens and the ongoing escalation of acquired antimicrobial resistance has impacted on the empirical and organism directed therapy of infectious diseases. Azithromycin and clarithromycin were developed by enhancing the basic macrolide structure. Some of the basic features associated with these new agents include a pharmacokinetic profiles that allow once or twice daily dosing with a much lower incidence of side effects and a substantially broader spectrum of activity which includes some Gram-negative bacilli, atypical pathogens and new, unconventional or uncommon pathogens. Clinical trial data has supported the use of "new" macrolides in a wide range of clinical indications, however, some specific indications are currently restricted to treatment with either azithromycin or clarithromycin. Macrolide resistance is a class effect and depending on the mechanism will confer either low or high level resistance. While resistance is problematic, it does not always result in clinical failure. The macrolides are a valuable class of antimicrobial agent and play an important role in the management of infectious diseases.

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Prophylaxis and Treatment of Pneumocystis Carinii Pneumonia

Lipman¹,

Johnson²

1997

AIDS and Respiratory Medicine

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RESULTS FROM RECENT THERAPEUTIC TRIALS FOR OPPORTUNISTIC INFECTIONS (Ols) FROM THE UNITED STATES

Cited by 8 publications

References 0 publications

Pneumocystis carinii infection: current treatment and prevention

Pneumocystis carinii infection: current treatment and prevention

The macrolides

Prophylaxis and Treatment of Pneumocystis Carinii Pneumonia

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