"A Controlled Trial of Aerosolized Pentamidine or" Trimethoprim-Sulfamethoxazole as Primary Prophylaxis Against Pneumocystis Carinii Pneumonia in Patients with Human Immunodeficiency Virus Infection

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"A Controlled Trial of Aerosolized Pentamidine or" Trimethoprim-Sulfamethoxazole as Primary Prophylaxis Against Pneumocystis Carinii Pneumonia in Patients with Human Immunodeficiency Virus Infection

New England Journal of Medicine (12/24/92) Vol. 327, No. 26, P. 1836
Schneider, Margriet M.E. et al.

Abstract: For primary prophylaxis against pneumocystis carinii pneumonia (PCP), trimethoprim-sulfamethoxazole is the drug of choice, despite the higher incidence of adverse events among patients administered the drug, write Margriet M.E. Schneider et al. of the University Hospital Utrecht in Utrecht, Netherlands. The researchers conducted a multicenter trial involving 215 HIV-positive patients with no history of PCP but with CD4 cell counts below 200 per cubic millimeter. The patients were randomly assigned to one of three regimens: aerosolized pentamidine once a month; 480 mg of trimethoprim-sulfamethoxazole once a day; or 960 of trimethoprim-sulfamethoxazole once a day. The cumulative incidence of PCP was estimated by Kaplan-Meier survival analysis. After a mean follow-up of 264 days, 6 of the 71 patients in the pentamidine group had a confirmed first occurrence of PCP (11 percent), but none of the patients in the two trimethoprim-sulfamethoxazole groups had PCP. Discontinuation of the drug due to side effects was much more frequent in the trimethoprim sulfamethoxazole groups than in the pentamidine group. The adverse reactions occurred significantly sooner in the group given 960 mg of trimethoprim-sulfamethoxazole than in the group given 480 mg. The researchers conclude that trimethoprim-sulfamethoxazole taken once a day is more effective as a primary prophylaxis against PCP than aerosolized pentamidine given once a month, even though adverse drug reactions are more common with trimethoprim-sulfamethoxazole.

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