TreatmentUpdate 74 - Volume 8, No 10; December 1996
Sean Hosein

Bactrim/Septra (B/S) is considered the best product for preventing the life-threatening lung infection PCP. Some PHAs may not be able to tolerate B/S. Despite successful therapy to help them tolerate the drug (called desensitization), some PHAs relapse and once more become intolerant of B/S. Options include use of other anti-PCP drugs -- dapsone, Mepron or AP (aerosol pentamidine). When AP is used the drug is made into a fine mist which is inhaled, delivering the drug where it is needed in the lungs with few side effects compared to intravenous pentamidine. Doctors in Italy conducted a study to compare the effect of the regular dose of AP -- 300 mg/month against that of a higher dose -- 600 mg/month.

Study details

Doctors assigned 107 subjects to receive AP 300 mg once each month and 98 others to receive AP 300 mg twice per month. About 20% of the subjects were female and 80% were male. At least half the subjects had a CD4+ count of roughly 65 cells. About 50% of subjects used AZT 600 mg/month. Subjects were not supposed to be using B/S, or other anti-PCP drugs while in the study. All subjects had recovered from an episode of PCP before joining this study.

Results

There were 14 cases of PCP in the 300 mg/month group and 5 cases in the 600 mg/month group. This difference was statistically significant, that is; not likely due to chance alone. As well, 15 subjects in the 300 mg group and 7 in the 600 mg group developed the life-threatening brain infection toxo (toxoplasmosis). This difference was not statistically significant.

Survival

Thirty-six subjects in the 300 mg group and 26 in the 600 mg group died (this difference was not statistically significant). Complications from PCP killed 5 subjects in the 300 mg group and 4 subjects in the 600 mg group. The remaining deaths were due to those normally seen in AIDS.

Toxicity

One subject in each group stopped participating in the study because they kept coughing while inhaling the drug and one of them had higher than normal levels of an enzyme called amylase. The doctors reported that no subject had their lungs collapse or coughed up blood while in the study.

References:

1. Rizzardi GP, Lazzarin A, Musicco M, et al. Better efficacy of twice-monthly than monthly aerosolized pentamidine for secondary prophylaxis of Pneumocystis carinii pneumonia in patients with AIDS. An Italian multicentric randomized controlled trial. Journal of Infection 1995;31:99-105.

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Copyright © 1996 - TreatmentUpdate. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Editor, The Canadian AIDS Treatment Information Exchange, 555 Richmond St. West, Suite 505, Box 1104, Toronto, ON, M5V 3B1 • Phone: 416-203-7122 • Toll Free: 1-800-263-1638 • Fax: 416-203-8284  http://www.catie.ca