Correspondence

Prevention and Treatment of Pneumocystis Pneumonia

N Engl J Med 1993; 328:1569May 27, 1993

Article

To the Editor:

Masur (Dec. 24 issue)1 reviewed the prevention and treatment of Pneumocystis carinii pneumonia (PCP). Two strategies to reduce the toxic effects of trimethoprim-sulfamethoxazole in patients infected with the human immunodeficiency virus (HIV) are worth pursuing. First, one study has suggested that giving 960 mg of trimethoprim-sulfamethoxazole three days a week can prevent PCP, with fewer side effects2. The longer drug-free intervals may facilitate the removal of the accumulated toxic metabolites of sulfamethoxazole. Second, van der Ven et al. have suggested the use of N-acetylcysteine therapy to replenish depleted stores of glutathione in persons with HIV infection3.

David I. Min, Pharm.D., M.S.
Saleem E. Noormohamed, Pharm.D., M.S.
University of Iowa College of Pharmacy, Iowa City, IA 52242

3 References

1. 1

   Masur H. Prevention and treatment of pneumocystis pneumonia. N Engl J Med 1992;327:1853-1860
   Full Text | Web of Science | Medline

2. 2

   Ruskin J, LaRiviere M. Low-dose co-trimoxazole for prevention of Pneumocystis carinii pneumonia in human immunodeficiency virus disease. Lancet 1991;337:468-471
   CrossRef | Web of Science | Medline

3. 3

   van der Ven AJAM, Koopmans PP, Vree TB, van der Meer JWM. Adverse reactions to co-trimoxazole in HIV infection. Lancet 1991;338:431-433
   CrossRef | Web of Science | Medline

To the Editor:

There is uncertainty about the best dose of aerosolized pentamidine for prophylaxis against PCP in HIV-infected persons. The use of aerosolized pentamidine in a dose of 300 mg once a month (delivered by a Respirgard II nebulizer) is associated with a substantial failure rate. It may be that a higher dosage would be needed to provide efficacy equal to that of trimethoprim-sulfamethoxazole. The results of our open study suggest that 600 mg of aerosolized pentamidine once a week is effective for primary and secondary prophylaxis against PCP.1 Until further prospective randomized trials are completed, physicians should consider the empirical use of higher doses of aerosolized pentamidine for prophylaxis against PCP.

E.L.C. Ong, M.R.C.P.
Newcastle General Hospital, Newcastle upon Tyne NE6 4BE, United Kingdom

B.K. Mandal, F.R.C.P.
Monsall Hospital, Manchester M10 8WR, United Kingdom

1 References

1. 1

   Ong ELC, Dunbar EM, Mandal BK. Efficacy and effects on pulmonary function tests of weekly 600 mg aerosol pentamidine as prophylaxis against Pneumocystis carinii pneumonia. Infection 1992;20:136-139
   CrossRef | Web of Science | Medline

Citing Articles (1)

Citing Articles

1. 1

   Gian Paolo Rizzardi, Adriano Lazzarin, Massimo Musicco, Daniela Frigerio, Myriam Maillard, Maurizio Lucchini, Mauro Moroni. (1995) Better efficacy of twice-monthly than monthly aerosolised pentamidine for secondary prophylaxis of Pneumocystis carinii pneumonia in patients with AIDS. An Italian multicentric randomised controlled trial. Journal of Infection 31:2, 99-105
   CrossRef