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A Meta-analysis of Salvage Therapy for Pneumocystis carinii Pneumonia
Raymond A. Smego, Jr, MD, MPH, DTM& ;H;
Shashi Nagar, BSc;
Bonnie Maloba, MBBCh;
Mirjana Popara, MBBCh
Arch Intern Med. 2001;161:1529-1533.
Objective To determine the relative efficacies of alternative antipneumocystis
agents in human immunodeficiency virus (HIV)–infected patients with Pneumocystis carinii pneumonia unresponsive to primary
drug treatment with a combination product of trimethoprim and sulfamethoxazole
or parenteral pentamidine.
Methods Meta-analysis of 27 published clinical drug trials, case series, and
case reports involving P carinii pneumonia. Data
extracted included underlying disease, primary antipneumocystis treatment,
days of failed primary treatment, salvage regimen, use of systemic corticosteroids
and antiretroviral drugs, and clinical outcome.
Results In 497 patients with microbiologically confirmed P carinii pneumonia (456 with HIV or acquired immunodeficiency syndrome),
initial antipneumocystis treatment failed and they therefore required alternative
drug therapy. Failed regimens included trimethoprim-sulfamethoxazole (160
patients), intravenous pentamidine (63 patients), trimethoprim-sulfamethoxazole
and/or pentamidine (258 patients), aerosolized pentamidine (6 patients), atovaquone
(3 patients), dapsone (3 patients), a combination product of trimethoprim
and dapsone (2 patients), and trimethoprim-sulfamethoxazole followed by a
combination of clindamycin and primaquine phosphate (2 patients). Efficacies
of salvage regimens were as follows: clindamycin-primaquine (42 to 44 [88%-92%]
of 48 patients; P<10-8), atovaquone
(4 [80%] of 5), eflornithine hydrochloride (40 [57%] of 70; P<.01), trimethoprim-sulfamethoxazole (27 [53%] of 51; P<.08), pentamidine (64 [39%] of 164), and trimetrexate (47 [30%]
of 159).
Conclusion The combination of clindamycin plus primaquine appears to be the most
effective alternative treatment for patients with P carinii pneumonia who are unresponsive to conventional antipneumocystis agents.
From the Department of Clinical Microbiology and Infectious Diseases,
University of the Witwatersrand/South African Institute for Medical Research,
and the Sizwe Tropical Diseases Hospital, Johannesburg, South Africa.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
A Review of Pneumocystis Pneumonia
Lee
Journal of Pharmacy Practice 2006;19:5-9.
ABSTRACT
Pneumocystis pneumonia in humans is caused by P jiroveci not P carinii
Miller et al.
Thorax 2004;59:83-84.
FULL TEXT
Clinical Practice in Sexually Transmissible Infections: Ed by A. McMillan, H. Young, M. M. Ogilvie, G. R. Scott. Pp608; {pound}93, 99, 2002. ISBN 0702025380.
Ojoo
Sex. Transm. Infect. 2003;79:429-429.
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