Antimicrobial Prophylaxis in Children with HIV Infection

Pediatric AIDS Clinical Trials Group describing a randomized comparison of daily administration of trimethoprim-sulfamethoxazole (TMP-SMZ) and atovaquone-azithromycin brings into focus a number of interesting issues related to HIV infections worldwide as well as the daily use of prophylactic antimicrobials in general. The trial was halted early before it was fully accrued and perhaps as a result of this it failed to achieve statistical significance for its central comparisons. However in spite of this early discontinuation the trial teaches us a few important lessons. Hughes and colleagues’ own landmark placebo-controlled randomized clinical trial that compared daily doses of TMP-SMZ with placebo in children with cancer and leukemia showed clearly in 1977 that not only was Pneumocystis jiroveci (formerly “carinii”) pneumonia (PCP) almost completely prevented but the numbers of proven and presumptive bacterial infections were also reduced significantly in this population of high-risk immunocompromised patients. In HIV infected adults very similar results were seen in a randomized comparison between aerosolized pentamidine and daily doses of TMP-SMZ published in 1992. (excerpt)