Aerosolized Pentamidine for Primary Prophylaxis of Pneumocystis Carinii Pneumonia

Jensen, Birgitte Nybo; Nielsen, Thyge Lynghosj; Backer, Vibeke; Nelsing, Suzanne; Simonsen, Lene; Flaschs, Helga; Gaub, Johs; Nielsen, Jens; Mathiesen, Lars; Skinhøj, Peter

doi:10.1097/00126334-199305000-00007

Cited by 11 publications

(3 citation statements)

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“…However, it is an alternative option for those unable to tolerate TMP-SMZ as stated in the most recent guidelines on the prevention of opportunistic infections in HIV-infected adults and adolescents. 75 Although aerosolized pentamidine has higher failure rates compared to bactrim, it has been shown that compared to those at risk and not receiving prophylactic therapy, it significantly reduces the incidence of primary episodes of PCP with reasonable tolerance of the inhaled drug 76…”

Section: Preventionmentioning

confidence: 99%

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Management of Pneumocystis Jirovecii pneumonia in HIV infected patients: current options, challenges and future directions

Castro¹,

Morrison-Bryant

2010

HIV

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The discovery of the Human Immunodeficiency Virus (HIV) was led by the merge of clustered cases of Pneumocystis jirovecii Pneumonia (PCP) in otherwise healthy people in the early 80’s.1,2 In the face of sophisticated treatment now available for HIV infection, life expectancy approaches normal limits. It has dramatically changed the natural course of HIV from a nearly fatal infection to a chronic disease.3–5 However, PCP still remains a relatively common presentation of uncontrolled HIV. Despite the knowledge and advances gained in the prevention and management of PCP infection, it continues to have high morbidity and mortality rates. Trimethoprim-sulfamethoxazole (TMP-SMZ) remains as the recommended first-line treatment. Alternatives include pentamidine, dapsone plus trimethoprim, clindamycin administered with primaquine, and atovaquone. For optimal management, clinicians need to be familiar with the advantages and disadvantages of the available drugs. The parameters used to classify severity of infection are also important, as it is well known that the adjunctive use of steroids in moderate to severe cases have been shown to significantly improve outcome. Evolving management practices, such as the successful institution of early antiretroviral therapy, may further enhance overall survival rates.

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Section: Preventionmentioning

confidence: 99%

“…75 Although aerosolized pentamidine has higher failure rates compared to bactrim, it has been shown that compared to those at risk and not receiving prophylactic therapy, it significantly reduces the incidence of primary episodes of PCP with reasonable tolerance of the inhaled drug. 76 …”

Section: Preventionmentioning

confidence: 99%

Management of Pneumocystis Jirovecii pneumonia in HIV infected patients: current options, challenges and future directions

Castro¹,

Morrison-Bryant

2010

HIV

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“…Aerosolized pentamidine continues to represent an effective and safe prophylaxis for human immunodeficiency virus (HIV)-associated Pneumocystis carinii pneumonia (PCP) [1][2][3]. Although oral co-trimoxazole has proved to be superior in patients with severe CD4-cell depletion (<100 CD4 cells·µL -1 ) and is also effective in preventing central nervous system (CNS) toxoplasmosis in patients with positive Toxoplasma gondii serology, the important advantages of aerosolized pentamidine are its minimal toxicity and its lack of interaction with other drugs.…”

mentioning

confidence: 99%

Effect of long-term primary aerosolized pentamidine prophylaxis on breakthrough Pneumocystis carinii pneumonia

Ewig¹,

Schäfer²,

Rockstroh³

et al. 1996

Eur Respir J

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Aerosolized pentamide is a well-tolerated primary prophylaxis regimen for Pneumocystis carinii pneumonia (PCP) in human immunodeficiency virus (HIV)-infected patients. It is now commonly administered for prolonged periods. We therefore studied the effect of long-term inhalation on breakthrough PCP.We recorded clinical, immunological, radiological and microbiological data, as well as therapy and clinical course of all episodes with confirmed PCP diagnosed at our institution between January 1, 1990 and June 30, 1995. Furthermore, data of all patients on primary aerosolized pentamidine since May 1, 1989 were retrieved. Prophylaxis failures were subdivided into "early" (≤12 months of inhalation time) and "late" (>12 months of inhalation time) failures and were compared with episodes without any prophylaxis.Thirty patients without any prophylaxis, six with early and 14 with late failures represented the study population. Mean±SD inhalation times were 4.9±4.8 and 26.3±14.1 months, respectively. No significant differences could be detected with regard to clinical presentation, severity of PCP, and in-hospital as well as long-term outcome. Early as well as late prophylaxis failures had a higher incidence of upper lobe infiltrates on chest radiography (50% without prophylaxis versus 100% with early and 83% with late failure, respectively; p<0.05). No extrapulmonary or disseminated pneumocystosis was observed in either group. The sensitivity of sitedirected bronchoalveolar lavage was conserved after long-term inhalation (86% versus 100% without prophylaxis and 97% in early failure; p=NS).The severity and outcome of Pneumocystis carinii pneumonia is not altered by long-term primary aerosolized pentamidine prophylaxis. Presentation with upper lobe infiltrates is a radiographic pattern also of late failures. Bronchoalveolar lavage should, therefore, be performed using the site-directed technique in this setting.

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A Meta-analysis of the Relative Efficacy and Toxicity of Pneumocystis carinii Prophylactic Regimens

Ioannidis

Cappelleri²,

Skolnik³

et al. 1996

Arch Intern Med

175

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Sulfamethoxazole-trimethoprim is the superior regimen, and low doses could improve tolerance without losing effectiveness for primary prophylaxis. Low doses of dapsone reduce toxic effects, but at the expense of some loss of efficacy. There are few data on the use of low-dose regimens for secondary prophylaxis. High doses of aerosolized pentamidine may improve the efficacy of this regimen. Aerosolized pentamidine is inadequate for prevention of toxoplasmosis, and strategies that improve the tolerance of oral regimens may increase effectiveness in preventing toxoplasmosis.

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Aerosolized Pentamidine for Primary Prophylaxis of Pneumocystis Carinii Pneumonia

Cited by 11 publications

References 0 publications

Management of Pneumocystis Jirovecii pneumonia in HIV infected patients: current options, challenges and future directions

Management of Pneumocystis Jirovecii pneumonia in HIV infected patients: current options, challenges and future directions

Effect of long-term primary aerosolized pentamidine prophylaxis on breakthrough Pneumocystis carinii pneumonia

A Meta-analysis of the Relative Efficacy and Toxicity of Pneumocystis carinii Prophylactic Regimens

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