Important note: Information in this article was accurate in 1991. The state of the art may have changed since the publication date.
AEROSOLIZED PENTAMIDINE FOR THE PREVENTION AND TREATMENT OF PNEUMOCYSTOSIS
AIDS Updates; 3(2):1-7 1990. Unique Identifier : AIDSLINE ICDB/91667835 Armstrong D; Bernard E; Infectious Disease Service, Dept. of Medicine, Memorial; Sloan-Kettering Cancer Center, New York, NY
Abstract:
Aerosolized pentamidine is a reasonable method to try to prevent pneumocystosis of the lung is in HIV-infected people. Studies so far demonstrate that it will not be 100% effective and that failures will occur in 5% to 25% of people. The more episodes of pneumocystis pneumonia a person has had, the greater the risk of a breakthrough on a given regimen. More frequent administration or higher doses may be necessary in this higher risk group of patients (pts). It is also possible that, in some pts with poor pulmonary function, there may be areas of the lung that cannot be reached and that these people will need systemic prophylaxis. In pts who have had pneumocystosis while receiving aerosol pentamidine prophylaxis and have been started on doses of 60 mg/wk after treatment, there have been breakthroughs. In these instances, we have chosen systemic prophylaxis. There is always the possibility that pentamidine resistance may develop during prophylaxis. Systemic prophylaxis has the additional advantage of apparent complete suppression of pneumocystosis in studies reported so far, and it should prevent dissemination of the pneumocystosis, which has occurred in pts on aerosol pentamidine. Atypical presentations and difficulty in documenting infection with P carinii have also been problems in using this method of prophylaxis. The question of pneumothoraces associated with aerosol pentamidine remains, but there is a suggestion that there is an association with repeated episodes of pulmonary pneumocystosis as well as active pneumocystosis at the time of the pneumothorax, along with a history of aerosolized pentamidine prophylaxis. Aerosolized pentamidine is not a reasonable method to treat pneumocystosis when used as sole therapy. It should only be used as an adjunct to systemic therapy in carefully controlled trials. (33 Refs)
Keywords: Administration, Inhalation Aerosols Animal Clinical Trials Dose-Response Relationship, Drug Drug Administration Schedule Drug Evaluation Human HIV Infections/COMPLICATIONS Pentamidine/*ADMINISTRATION & DOSAGE/ADVERSE EFFECTS Pneumocystis carinii/DRUG EFFECTS Pneumonia, Pneumocystis carinii/*DRUG THERAPY/PREVENTION & CONTROL JOURNAL ARTICLE 910430
M9140689
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Important note: Information in this article was accurate in 1991. The state of the art may have changed since the publication date.
