title: The possible role of corticosteroid therapy for pneumocystis pneumonia in the acquired immune deficiency syndrome (AIDS).
abstract: Twenty-one episodes of Pneumocystis carinii pneumonia (PCP) and the acquired immune deficiency syndrome (AIDS) were treated with corticosteroids in the form of intravenous methylprednisolone or oral prednisone. A standard dose of 80 mg/day x 5 days was given for 15 episodes, whereas 6 patients received variable doses of 20-120 mg/day x 4-20 days. All were treated with trimethoprim-sulfamethoxazole (TMP-SMX). Comparison was made with 12 AIDS patients with PCP who were not treated with steroids. The steroid group was more severely ill than the controls as measured by alveolar-arterial oxygen difference but were otherwise comparable. Mortality from the pneumonia in the steroid group was 2/21 (10%) vs. 3/12 (25%) in the control group. Significant differences were seen in the following parameters: time to defervescence (1 day vs. greater than 9.3 days), the proportion of patients with pO2 greater than 70 mm Hg at day 5 [12/21 (57%) vs. 1/12 (9%)] and at day 10 [19/21 (90%) vs. 7/12 (58%)], and number of adverse drug reactions [4/21 (19%) vs. 9/12 (75%)]. There were fewer late relapses [1/19 (5%) vs. 2/9 (22%)] after a 5.5 month (mean) follow-up. All patients had improvements in their clinical status when initially given corticosteroid therapy but early relapses occurred when steroids were discontinued in five patients (24%). No other complications could be attributed to steroid therapy in this study. A brief course of high-dose corticosteroids appears to be beneficial in severely ill AIDS patients with pneumocystis pneumonia. This suggests the need for randomized, double-blind, placebo-controlled trials to confirm these findings.
authors.affiliation: Department of Medicine, Toronto General Hospital, Ontario, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Walmsley
authors.forename: I E
authors.initials: IE
authors.lastname: Salit
authors.forename: J
authors.initials: J
authors.lastname: Brunton
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D004334:Drug Administration Schedule; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D010865:Pilot Projects; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy*; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use*; D011659:Pulmonary Gas Exchange; D013420:Sulfamethoxazole / Q000008:administration & dosage / Q000627:therapeutic use*; D014295:Trimethoprim / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D014295:Trimethoprim; D013420:Sulfamethoxazole; D011241:Prednisone; D008775:Methylprednisolone