Eflornithine versus cotrimoxazole in the treatment of Pneumocystis carinii pneumonia in AIDS patients.
OBJECTIVE
To compare cotrimoxazole and eflornithine as primary treatment for first-episode Pneumocystis carinii pneumonia (PCP).


METHODS
Prospective open-labelled study.


METHODS
Patients were randomized to eflornithine (400 mg/kg daily, as a continuous intravenous infusion) or cotrimoxazole (3.84 g twice daily, intravenously) for 14 days.


RESULTS
Only 39% of patients treated with eflornithine (20 out of 51) and 40% of those given cotrimoxazole (nine out of 47) successfully completed therapy. Although 12 out of the 36 patients with confirmed PCP were treated successfully with eflornithine, significantly more patients were withdrawn from the eflornithine group because of therapy failure (25 out of 51 versus 10 out of 47, P = 0.007). This significant difference persisted in patients in whom a diagnosis of PCP was confirmed histologically (19 out of 33 versus seven out of 27, P = 0.03). Significantly more patients were withdrawn from cotrimoxazole because of serious drug-related side-effects (38 versus 12%, P = 0.005).


CONCLUSIONS
Eflornithine (400 mg/kg daily) is less effective than cotrimoxazole (7.68 g daily) as treatment for first-episode PCP. Eflornithine does have activity against P. carinii in humans.
Smith
D E
DE
AIDS Research Unit, Westminster Hospital, London, UK.
Davies
S
S
Smithson
J
J
Harding
I
I
Gazzard
B G
BG
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy*; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D000518:Eflornithine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy*; D011446:Prospective Studies; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*
D000305:Adrenal Cortex Hormones; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D000518:Eflornithine