Markedly Reduced Mortality Associated With Corticosteroid Therapy of Pneumocystis carinii Pneumonia in Children With Acquired Immunodeficiency Syndrome

Bye, Michael R.; Cairns-Bazarian, Anne Marie; Ewig, Jeffrey M.

doi:10.1001/archpedi.1994.02170060092018

Cited by 54 publications

(12 citation statements)

References 23 publications

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“…The latter difference may be because there is easier access to treatment options, including oxygen therapy, and greater use of steroids in our region [23,24]. Although the use of steroids did not affect mortality among children with PCP in our study, the result may have been different had mechanical ventilation been available [23,24]. Some children with PCP survived, despite having received either inadequate treatment (16 [84%] of 19 children) or no treatment at all (3 [75%] of 4 children), which has been reported elsewhere for HIV-1-infected adults [20].…”

Section: Discussionmentioning

confidence: 98%

Ineffectiveness of Trimethoprim‐Sulfamethoxazole Prophylaxis and the Importance of Bacterial and Viral Coinfections in African Children withPneumocystis cariniiPneumonia

et al. 2002

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African human immunodeficiency virus type 1 (HIV-1)-infected children were evaluated to define the burden of Pneumocystis carinii pneumonia (PCP) and its interaction with bacterial and viral pathogens. P. carinii was identified in 101 (43.7%) of 231 episodes of pneumonia among 185 HIV-1-infected children (median age, 4.5 months; range, 1.7-27.3 months). Receipt of trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis was not associated with a significant reduction (36%; 95% confidence interval [CI], -15.4% to 64.5%) in isolation of P. carinii among children considered to have received adequate prophylaxis (37.7% of children) compared with children who had never received any prophylaxis (48.5% of children). However, deaths among children with PCP who had been taking TMP-SMX prophylaxis were markedly reduced (98.6%; 95% CI, 89.1%-99.8%) compared with children who were not taking prophylaxis. Concurrent P. carinii infection was observed in 6 of 18, 11 of 26, and 4 of 6 HIV-1-infected children who had bacteremia, a respiratory virus isolated, or Mycobacterium species isolated, respectively.

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Section: Discussionmentioning

confidence: 98%

Ineffectiveness of Trimethoprim‐Sulfamethoxazole Prophylaxis and the Importance of Bacterial and Viral Coinfections in African Children withPneumocystis cariniiPneumonia

et al. 2002

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“…The case-fatality rates among the treatment and control group were 0% and 30%, respectively. 43 This study was graded as low-quality evidence, as there was inadequate information specifying eligibility criteria, diagnostic workup, ancillary care, other prognostic factors, and whether the follow-up periods were comparable between the 2 groups. Pooled analysis for the adjunctive corticosteroid therapy was not deemed to be appropriate, given the substantial clinical and statistical heterogeneity of the studies.…”

Section: Antibiotic and Other Adjunctive Management Of Cap In Hiv-infmentioning

confidence: 99%

Systematic Review on the Etiology and Antibiotic Treatment of Pneumonia in Human Immunodeficiency Virus-infected Children

Punpanich

Groome²,

Muhe³

et al. 2011

Pediatric Infectious Disease Journal

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A World Health Organization panel used this review as well as analysis of risks and benefits to revise recommendations for antimicrobial treatment of CAP. Ampicillin plus gentamicin or ceftriaxone is now recommended as first-line empiric regimens for treating severe and very severe CAP in HIV-infected children. In addition, treatment with cloxacillin or vancomycin is recommended in settings with a high incidence of methicillin-resistant S. aureus, and particularly if clinical or microbiological evidence of S. aureus pneumonia exist. Further studies in HIV-infected children on CAP etiology and antibiotic treatment are required in the era of antiretroviral treatment.

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“…On the basis of studies in both adults 75–79 and children, 80 a short course of corticosteroids is recommended in cases of moderate or severe PCP, starting within 72 hours of diagnosis (AI*) . Pediatric studies have indicated reduced acute respiratory failure, decreased need for ventilation, and decreased mortality with early use of corticosteroids in HIV-infected children who have PCP.…”

Section: Pneumocystis Jirovecii Pneumonia (Last Updated November 6 2mentioning

confidence: 99%

“…Pediatric studies have indicated reduced acute respiratory failure, decreased need for ventilation, and decreased mortality with early use of corticosteroids in HIV-infected children who have PCP. 80–82 Indications for corticosteroid treatment include a PaO 2 value of <70 mm Hg or an alveolar-arterial gradient of >35 mm Hg. Doses for children vary between studies.…”

Section: Pneumocystis Jirovecii Pneumonia (Last Updated November 6 2mentioning

confidence: 99%

Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children

Siberry

Abzug

Nachman

et al. 2013

Pediatric Infectious Disease Journal

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Markedly Reduced Mortality Associated With Corticosteroid Therapy of Pneumocystis carinii Pneumonia in Children With Acquired Immunodeficiency Syndrome

Cited by 54 publications

References 23 publications

Ineffectiveness of Trimethoprim‐Sulfamethoxazole Prophylaxis and the Importance of Bacterial and Viral Coinfections in African Children withPneumocystis cariniiPneumonia

Ineffectiveness of Trimethoprim‐Sulfamethoxazole Prophylaxis and the Importance of Bacterial and Viral Coinfections in African Children withPneumocystis cariniiPneumonia

Systematic Review on the Etiology and Antibiotic Treatment of Pneumonia in Human Immunodeficiency Virus-infected Children

Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children

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