Furazolidone and nitrofurantoin, oral nitrofuran derivatives with broad-spectrum antimicrobial properties already in clinical use, were compared for activity against Pneumocystis carinii in an immunosuppressed rat model of P. carinii pneumonia. Furazolidone exhibited only slight activity as a prophylactic agent but was moderately effective in the therapy of pneumocystosis. The median histologic score and organism count fell from 4+ and and their toxic effects on the rats will probably discourage investigation of this drug in the treatment of pneumocystosis in humans. Nevertheless, since many nitrofurans have been synthesized, further exploration of this class of compounds might be helpful in developing new anti-P. carinii agents or in studying structureactivity relationships.Pneumocystis carinii is a leading cause of pneumonia in immunosuppressed patients. The incidence of pneumocystosis has increased markedly over the past decade in association with the emergence of AIDS (34). Treatment of P. carinii pneumonia in AIDS patients has been hindered by a high frequency of recurrence and of toxic reactions to antimicrobial drugs. Anti-P. carinii compounds currently in clinical use include inhibitors of dihydrofolate reductase (e.g., trimethoprim [TMP], trimetrexate), sulfonamides (sulfamethoxazole [SMX]), and sulfones (dapsone); diamidines (pentamidine isethionate); polyamine inhibitors (adifluromethylornithine); and the combination of clindamycin and primaquine (2,11,13,21,27).Our laboratory has been engaged in developing new forms of P. carinii therapy for the past several years (8,15,35,36). Drug selection has been hampered by the lack of knowledge about the metabolic pathways of the organism. Studies are conducted in an animal model in which rats given corticosteroids spontaneously develop pneumocystosis by a process of reactivation of latent infection. Although this system permits evaluation of relatively few compounds, it has been a reliable predictor of drug activity in humans (10, 12).Here we report our experience with two nitrofuran derivatives, furazolidone and nitrofurantoin. Nitrofurans possess broad antimicrobial properties, including activity against trypanosomes (4,20,25,26,29,31). Our rationale for testing them against P. carinii was based on the following considerations. First, several classes of drugs (e.g., diamidines, polyamine inhibitors, purine nucleosides) with antitrypanosomal properties have been shown to be effective against P. carinii, although the specific mechanisms of action are unknown (8,21,28,36). Second, since furazolidone and nitrofurantoin are oral preparations and are already in clinical use, they would be much easier to develop as anti-P. carinii drugs than would unlicensed compounds with poorly * Corresponding author. understood pharmacokinetic properties or toxicological profiles.
MATERIALS AND METHODSExperimental design. (i) Treatment. The animal protocol that we used has been described in detail previously (15,(35)(36)(37). In brief, adult male Sprague-Dawley rats (Harlan I...