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Catherine Butkus Small, MD; Carol A. Harris, MD; Gerald H. Friedland, MD; Robert S. Klein, MD

Arch Intern Med. 1985;145(5):837-840.

Abstract
• Forty-four episodes of Pneumocystis carinii pneumonia (PCP) occurred in 36 of 70 patients with the acquired immunodeficiency syndrome. Thirty-four patients with 40 episodes of PCP were treated with trimethoprim-sulfamethoxazole. Therapy was successful in 18 episodes (45%), but was unsuccessful in 15 episodes (37.5%). In the latter cases, two patients died within 72 hours; 13, of whom nine died, had therapy changed to pentamidine. In seven additional episodes (17.5%), trimethoprim-sulfamethoxazole was changed to pentamidine due to adverse reactions; all patients survived. Seven patients (26% of survivors) developed recurrent PCP. Twenty-two patients (65%) developed adverse reactions to trimethoprim-sulfamethoxazole, including leukopenia (20), hepatotoxicity (12), fever (eight), rash (six), and immediate reactions (two). Reactions were most common during the second week of therapy. Patients with the acquired immunodeficiency syndrome who have PCP have a high trimethoprim-sulfamethoxazole failure rate, due either to adverse reactions or unresponsive infection. Late recurrence is common.

(Arch Intern Med 1985;145:837-840)

Author Affiliations
From the Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center and North Central Bronx Hospital (Drs Small, Harris, Friedland, and Klein), and the Department of Medicine, Albert Einstein College of Medicine (Drs Small, Harris, Friedland, and Klein), Bronx, NY. Dr Small is now with the Westchester County Medical Center, Valhalla, NY.

Footnotes
Accepted for publication Sept 21, 1984.

Read in part before the 23rd Interscience Conference on Antimicrobial Agents and Chemotherapy, Las Vegas, Oct 25, 1983.

Reprint requests to Division of Infectious Diseases, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (Dr Klein).

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