Inhaled pentamidine for P. carinii pneumonia - Pneumocystis carinii pneumonia - Tips From Other Jour

Date: August, 1991

Pneumocystis carinii pneumonia is the most important opportunistic infection in patients with the acquired immunodeficiency syndrome. Since the infection is usually restricted to the lungs, inhaled pentamidine has been shown to be effective in preventing relapse in patients who have had an episode of P. carinii pneumonia. While the use of inhaled pentamidine has been accepted in secondary prevention of P. carinii pneumonia, its use in primary prevention has not been well evaluated. In a European study, Hirschel and colleagues evaluated the efficacy of inhaled pentamidine in the primary prevention of P carinii pneumonia.

Included in the study were 223 patients who were seropositive for human immunodeficiency virus (HIV), had no history of R carinii pneumonia and had CD4 Tlymphocyte counts of less than 200 per mm 3(200 X 10.sup.6 per L). Patients received either 300 mg of pentamidine isethionate (114 patients) or 300 mg of sodium isethionate (109 patients) every 28 days by inhaler.

After one year, eight patients receiving pentamidine had an episode of P carinii pneumonia (an incidence of 8.6 percent per patient-year), compared with 23 patients receiving placebo (27.1 percent per patient-year). With the exception of occasional moderate to severe coughing, pentamidine was well tolerated.

The study findings indicate that inhaled pentamidine is 60 to 70 percent effective in preventing a first episode of P carinii pneumonia in patients with HIV infection. (New England Journal of Medicine, April 18, 1991, vol. 324, p. 1079.)

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