Trimethoprim-Sulfamethoxazole or Pentamidine forPneumocystis cariniiPneumonia in the Acquired Immunodeficiency Syndrome

Abstract

Forty patients with the acquired immunodeficiency syndrome (AIDS) and their first episodes of Pneumocystis carinii pneumonia were assigned at random to receive either trimethoprim-sulfamethoxazole or pentamidine isethionate. The two groups did not differ significantly in the severity of pulmonary or systemic processes at enrollment. Five patients treated initially with trimethoprim-sulfamethoxazole and one patient treated initially with pentamidine died during the 21-day treatment period (p = 0.09, Fisher's exact test). No significant differences were seen between groups in rates of improvement, pulmonary function tests, or 67Ga uptake by the lungs in the survivors at completion of therapy. Adverse reactions necessitated changing from the initial drug in 10 patients in the trimethoprim-sulfamethoxazole group and 11 in the pentamidine group. Minor reactions occurred in all patients. In patients with AIDS, trimethoprim-sulfamethoxazole and pentamidine do not have statistically significant differences in efficacy or frequency of adverse reactions.

New Insights Into Transmission, Diagnosis, and Drug Treatment of <EMPH TYPE="ITAL">Pneumocystis carinii</EMPH> Pneumonia

“…T h e c o m b i n a t i o n o f trimethoprim-sulfamethoxazole is the current first-line therapeutic agent; treatment should be continued for 14 to 21 days for most patients. 13,14 Advances in Understanding the Biology of P carinii Substantial advances have been made over the past 2 decades in understanding the biology of P carinii. To highlight these advances, it is helpful to compare what was known about the organism in the pre-AIDS era in the 1970s with what is known today.…”

Immunohistological assessment of cutaneous drug hypersensitivity in patients with HIV infection

“…Features of IgE-mediated hypersensitivity have not been observed. Hypersensitivity is significantly more common in patients with HIV infection than in those with other immunodeficiency disorders or in the general population [3][4][5][6][7]. Thc causes and mechanisms of this hypersensitivity are not known, but are likely to include a high dose or prolonged duration of therapy, the degree of immunodeficiency, a slow acetylation phenotype, glutathione deficiency, and perhaps coexisting viral infection or immune complex deposition [8][9][10], Hypersensitivity to trimethoprim-sulphamethoxazole Correspondence: Dr Andrew Carr, Centre for Immunology, Si.…”

Cutaneous Ulceration: An Unusual Complication of Intravenous Pentamidine Therapy

“…The reasons for this include: (1) reports by some authors of equal efficacy of pentamidine versus trimetho prim-sulfamethoxazole in the treatment of Pneumocystis pneumonia in AIDS patients [5,12] and (2) the high fre quency in AIDS patients of significant adverse reactions to trimethoprim-sulfamethoxazole such as severe skin eruptions, fever, neutropenia, thrombocytopenia, liver dysfunction and azotemia [13], Pentamidine should be added to the list of drugs that can lead to severe chemical cellulitis and ulceration fol lowing extravasation into perivascular tissues [14,15]. These drugs can be divided into several groups based upon the proposed mechanism for cutaneous necrosis [16], Vasopressors such as norepinephrine and dobutamine cause vasoconstriction which leads to ischemia, while chemotherapeutic agents such as doxorubicin, daunorubicin, nitrogen mustard, actinomycin D and the vinca alkaloids act by direct cytotoxicity.…”