Inhaled or intravenous pentamidine therapy for Pneumocystis carinii pneumonia in AIDS. A randomized trial.

Abstract:

OBJECTIVE:To compare inhaled pentamidine with intravenous pentamidine for the treatment of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome (AIDS). DESIGN:A randomized trial. SETTING:Community teaching hospital and hospital-based outpatient treatment center. PATIENTS:Twenty-one homosexual men with pneumocystis pneumonia; 11 received inhaled pentamidine and 10 received intravenous pentamidine. INTERVENTION:Inhaled (8 mg/kg body weight) or intravenous (4 mg/kg body weight) pentamidine administered daily for 21 days. MEASUREMENTS AND MAIN RESULTS:All patients responded to intravenous pentamidine, whereas 6 of 11 (55%; 95% CI, 23% to 83%; P = 0.02, Fisher exact test) responded to inhaled pentamidine therapy. Two patients who failed inhaled pentamidine therapy eventually died despite appropriate intravenous therapy (mortality rate, 18%; CI, -6% to 42%). Nonresponders to inhaled pentamidine had a greater severity of illness compared with responders to this therapy, as shown by a lower mean (+/- SE) Pao2 (8.0 +/- 0.4 kPa compared with 10.8 +/- 0.6 kPa; P = 0.005) and higher alveolararterial Po2 difference (6.8 +/- 0.6 kPa compared with 2.8 +/- 0.8 kPa; P = 0.003). CONCLUSIONS:Inhaled pentamidine is probably as effective as intravenous pentamidine in patients with mild pneumocystis pneumonia. However, its use as sole therapy in patients with moderate to severe pneumocystis pneumonia is not supported by the results of our study and is not warranted.

journal_name

Ann Intern Med

authors

Soo Hoo GW,Mohsenifar Z,Meyer RD

doi

10.7326/0003-4819-113-3-195

subject

Has Abstract

pub_date

1990-08-01 00:00:00

pages

195-202

issue

3

eissn

0003-4819

issn

1539-3704

journal_volume

113

pub_type

临床试验,杂志文章,随机对照试验
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