Corticosteroids for Pneumocystis carinii pneumonia with acute respiratory failure. Experience with rescue therapy.
Corticosteroids have proven effective as adjunctive therapy for the treatment of PCP in patients with AIDS, when begun within 72 h of conventional anti-Pneumocystis therapy. Their efficacy as rescue (or salvage) therapy in patients who have failed conventional therapy, however, remains unproven. Ths report presents our experience with 16 patients admitted to our MICU for acute respiratory failure (PaO2/FIO2 ratio less than or equal to 150) due to PCP. Five of six patients (83 percent) who received "primary" CS rescue (initial CS use prompted by acute respiratory failure after 72 h of conventional anti-Pneumocystis therapy) survived hospitalization. Our experience suggests that CSs may be effective even when started after 72 h of conventional therapy. Additional studies are needed to clarify the role of CS rescue therapy.
LaRocco
A
A
Department of Internal Medicine (Infectious Disease Division), Naval Hospital, San Diego.
Amundson
D E
DE
Wallace
M R
MR
Malone
J L
JL
Oldfield
E C
EC
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D003422:Critical Care; D006801:Humans; D008775:Methylprednisolone / Q000627:therapeutic use*; D010419:Pentamidine / Q000627:therapeutic use; D011020:Pneumonia, Pneumocystis / Q000150:complications / Q000188:drug therapy*; D011241:Prednisone / Q000627:therapeutic use*; D012131:Respiratory Insufficiency / Q000209:etiology*; D016879:Salvage Therapy; D013997:Time Factors; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D010419:Pentamidine; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D011241:Prednisone; D008775:Methylprednisolone