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The Treatment of Pneumocystis carinii Pneumonia in the Acquired Immunodeficiency Syndrome

The Treatment of Pneumocystis carinii Pneumonia in the Acquired Immunodeficiency Syndrome 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) References 1. Update: Acquired immunodeficiency syndrome (AIDS)—United States. MMWR 1984;33:337-339. 2. Update on Kaposi's sarcoma and opportunistic infections in previously healthy persons—United States. MMWR 1982;31:294-301. 3. Moll B, Emeson EE, Small CB, et al: Inverted ratio of inducer to suppressor T lymphocyte subsets in drug abusers with opportunistic infections. Clin Immunol Immunopathol 1982;25:417-423.Crossref 4. Rubinstein A, Das KM, Melamed J, et al: Comparative analysis of systemic immunological parameters in ulcerative colitis and idiopathic proctitis: Effects of sulfasalazine in vivo and in vitro. Clin Exp Immunol 1978;33:217-224. 5. Rubin RH, Swartz MN: Trimethoprim-sulfamethoxazole. N Engl J Med 1980;303:426-432.Crossref 6. Fauci AS, Macher AM, Longo DL, et al: Acquired immunodeficiency syndrome: Epidemiologic, clinical, immunologic, and therapeutic considerations. Ann Intern Med 1984;100:92-106.Crossref 7. Haverkos HW: Assessment of therapy for Pneumocystis carinii pneumonia. Am J Med 1984;76:501-508.Crossref 8. Kovacs JA, Hiemenz JW, Macher AM, et al: Pneumocystis carinii pneumonia: A comparison between patients with the acquired immunodeficiency syndrome and patients with other immunodeficiencies. Ann Intern Med 1984;100:663-671.Crossref 9. Young LS: Trimethoprim-sulfamethoxazole in the treatment of adults with pneumonia due to Pneumocystis carinii. Rev Infect Dis 1982;4:608-613.Crossref 10. Hughes WT: Trimethoprim-sulfamethoxazole therapy for Pneumocystis carinii pneumonitis in children. Rev Infect Dis 1982;4:602-607.Crossref 11. Sattler FR, Remington JS: Intravenous trimethoprim-sulfamethoxazole therapy for Pneumocystis carinii pneumonia. Am J Med 1981;70: 1215-1221.Crossref 12. Winston DJ, Lau WK, Gale RP, et al: Trimethoprim-sulfamethoxazole for the treatment of Pneumocystis carinii pneumonia. Ann Intern Med 1980;92:762-769.Crossref 13. Kluge RM, Spaulding DM, Spain AJ: Combination of pentamidine and trimethoprim-sulfamethoxazole in the therapy of Pneumocystis carinii pneumonia in rats. Antimicrob Agents Chemother 1978;13:975-978.Crossref 14. Fauci AS: The syndrome of Kaposi's sarcoma and opportunistic infections: An epidemiologically restricted disorder of immunoregulation. Ann Intern Med 1982;96:777-779.Crossref 15. Hughes WT, Johnson WW: Recurrent Pneumocystis carinii pneumonia following apparent recovery. J Pediatr 1971;79:755-759.Crossref 16. Gordin FM, Simm GL, Wofsy CB, et al: Adverse reactions to trimethoprim-sulfamethoxazole in patient with the acquired immunodeficiency syndrome. Ann Intern Med 1984;100:495-499.Crossref 17. Jick H: Adverse reactions to trimethoprim-sulfamethoxazole in hospitalized patients. Rev Infect Dis 1982;4:426-428.Crossref 18. Jaffe HS, Abrams DI, Ammann AJ, et al: Complications of co-trimoxazole in treatment of AIDS-associated Pneumocystis carinii pneumonia in homosexual men. Lancet 1983;2:1109-1111.Crossref 19. Wormser GP, Krupp LB, Hanrahan JP, et al: Acquired immunodeficiency syndrome in male prisoners. Ann Intern Med 1983;98:297-303.Crossref 20. Mitsuyasu R, Groopman J, Volberding P: Cutaneous reaction to trimethoprim-sulfamethoxazole in patients with AIDS and Kaposi's sarcoma. N Engl J Med 1983;308:1535-1536.Crossref 21. Bushby SRM: Trimethoprim-sulfamethoxazole: In vitro microbiological aspects. J Infect Dis 1973;128( (suppl) ):S447-S462.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

The Treatment of Pneumocystis carinii Pneumonia in the Acquired Immunodeficiency Syndrome

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Publisher
American Medical Association
Copyright
Copyright © 1985 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1985.00360050081015
Publisher site
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Abstract

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) References 1. Update: Acquired immunodeficiency syndrome (AIDS)—United States. MMWR 1984;33:337-339. 2. Update on Kaposi's sarcoma and opportunistic infections in previously healthy persons—United States. MMWR 1982;31:294-301. 3. Moll B, Emeson EE, Small CB, et al: Inverted ratio of inducer to suppressor T lymphocyte subsets in drug abusers with opportunistic infections. Clin Immunol Immunopathol 1982;25:417-423.Crossref 4. Rubinstein A, Das KM, Melamed J, et al: Comparative analysis of systemic immunological parameters in ulcerative colitis and idiopathic proctitis: Effects of sulfasalazine in vivo and in vitro. Clin Exp Immunol 1978;33:217-224. 5. Rubin RH, Swartz MN: Trimethoprim-sulfamethoxazole. N Engl J Med 1980;303:426-432.Crossref 6. Fauci AS, Macher AM, Longo DL, et al: Acquired immunodeficiency syndrome: Epidemiologic, clinical, immunologic, and therapeutic considerations. Ann Intern Med 1984;100:92-106.Crossref 7. Haverkos HW: Assessment of therapy for Pneumocystis carinii pneumonia. Am J Med 1984;76:501-508.Crossref 8. Kovacs JA, Hiemenz JW, Macher AM, et al: Pneumocystis carinii pneumonia: A comparison between patients with the acquired immunodeficiency syndrome and patients with other immunodeficiencies. Ann Intern Med 1984;100:663-671.Crossref 9. Young LS: Trimethoprim-sulfamethoxazole in the treatment of adults with pneumonia due to Pneumocystis carinii. Rev Infect Dis 1982;4:608-613.Crossref 10. Hughes WT: Trimethoprim-sulfamethoxazole therapy for Pneumocystis carinii pneumonitis in children. Rev Infect Dis 1982;4:602-607.Crossref 11. Sattler FR, Remington JS: Intravenous trimethoprim-sulfamethoxazole therapy for Pneumocystis carinii pneumonia. Am J Med 1981;70: 1215-1221.Crossref 12. Winston DJ, Lau WK, Gale RP, et al: Trimethoprim-sulfamethoxazole for the treatment of Pneumocystis carinii pneumonia. Ann Intern Med 1980;92:762-769.Crossref 13. Kluge RM, Spaulding DM, Spain AJ: Combination of pentamidine and trimethoprim-sulfamethoxazole in the therapy of Pneumocystis carinii pneumonia in rats. Antimicrob Agents Chemother 1978;13:975-978.Crossref 14. Fauci AS: The syndrome of Kaposi's sarcoma and opportunistic infections: An epidemiologically restricted disorder of immunoregulation. Ann Intern Med 1982;96:777-779.Crossref 15. Hughes WT, Johnson WW: Recurrent Pneumocystis carinii pneumonia following apparent recovery. J Pediatr 1971;79:755-759.Crossref 16. Gordin FM, Simm GL, Wofsy CB, et al: Adverse reactions to trimethoprim-sulfamethoxazole in patient with the acquired immunodeficiency syndrome. Ann Intern Med 1984;100:495-499.Crossref 17. Jick H: Adverse reactions to trimethoprim-sulfamethoxazole in hospitalized patients. Rev Infect Dis 1982;4:426-428.Crossref 18. Jaffe HS, Abrams DI, Ammann AJ, et al: Complications of co-trimoxazole in treatment of AIDS-associated Pneumocystis carinii pneumonia in homosexual men. Lancet 1983;2:1109-1111.Crossref 19. Wormser GP, Krupp LB, Hanrahan JP, et al: Acquired immunodeficiency syndrome in male prisoners. Ann Intern Med 1983;98:297-303.Crossref 20. Mitsuyasu R, Groopman J, Volberding P: Cutaneous reaction to trimethoprim-sulfamethoxazole in patients with AIDS and Kaposi's sarcoma. N Engl J Med 1983;308:1535-1536.Crossref 21. Bushby SRM: Trimethoprim-sulfamethoxazole: In vitro microbiological aspects. J Infect Dis 1973;128( (suppl) ):S447-S462.Crossref

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Archives of Internal Medicine – American Medical Association

Published: May 1, 1985

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