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Comparison of Trimethoprim‐Sulfamethoxazole, Dapsone, and Pentamidine in the Prophylaxis of Pneumocystis carinii Pneumonia
Author(s) -
Warnock Allison C.,
Rimland David
Publication year - 1996
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/j.1875-9114.1996.tb03029.x
Subject(s) - pentamidine , dapsone , medicine , trimethoprim , pneumocystis carinii , pneumonia , sulfamethoxazole , incidence (geometry) , pneumocystis pneumonia , population , surgery , dermatology , antibiotics , pneumocystis jirovecii , microbiology and biotechnology , physics , environmental health , optics , biology
Study Objective . To compare the incidence of Pneumocystis carinii pneumonia (PCP) in patients infected with the human immunodeficiency virus (HIV) receiving one of three prophylactic agents. Design . Retrospective chart review. Setting . A university‐affiliated Department of Veterans' Affairs medical center HIV clinic. Patients . All 200 HIV‐infected patients enrolled in the clinic who were prescribed a PCP prophylactic drug during 18 months. Interventions . Patients were administered oral trimethoprim‐sulfamethoxazole (TMP‐SMX) DS, oral dapsone, or aerosolized pentamidine in a heirarchic fashion. A subset of 110 patients received only one of the prophylaxis regimens for at least 6 months; they were examined separately for the purpose of statistical analysis. Measurements and Main Results . One case of PCP was diagnosed in 1110 patient‐months of oral TMP‐SMX DS therapy, 6 in 418 patient‐months of oral dapsone therapy, and 3 in 164 patient‐months of aerosolized pentamidine therapy. In the subset population, the documented incidence of PCP was 0% among 71 TMP‐SMX DS‐treated patients, 16% among 25 dapsone‐treated patients (p < 0.004), and 14% among 14 aerosolized pentamidine‐treated patients (p < 0.03). For patients receiving primary prophylaxis, the incidence of PCP was 0% for 58 receiving TMP‐SMX, 15% for 20 receiving dapsone (p = 0.015), and 17% for 6 receiving pentamidine (p = 0.094). Conclusion . We believe TMP‐SMX DS was more effective than oral dapsone or aerosolized pentamidine in preventing PCP in these HIV‐infected patients.