The use of aerosolized pentamidine for prophylaxis of Pneumocystis carinii pneumonia in children with leukemia.
We report our experience giving aerosolized pentamidine as prophylaxis for Pneumocystis carinii pneumonia (PCP) to 9 children (mean age, 7.33 years; range 3-17 years) with leukemia who were unable to tolerate trimethoprim-sulfamethoxazole (TMP-SMX) due to allergy or myelosuppression. The dose of pentamidine was modified for each child to correct for weight and approximate alveolar ventilation. We were able to administer the drug to younger children by using a cushioned face mask in place of the standard mouthpiece. One child experienced moderate coughing with administration of pentamidine. He and four others with a past medical history suggestive of reactive airways disease were pretreated with inhaled albuterol. No other adverse effects were noted. Treatment lasted an average of 8.11 +/- 4.1 months per child; no case of PCP occurred. We conclude that aerosolized pentamidine can be administered to even very young children and may be of benefit to all immunosuppressed children unable to use TMP-SMX prophylaxis. The adjusted dose used here appears to be safe, but further studies regarding drug delivery and efficacy are needed.
Department of Pediatrics, University of Massachusetts Medical Center, Worcester 01655.
B P
BP
O'Sullivan
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R
Spaulding
D000293:Adolescent; D000336:Aerosols; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007948:Leukemia, Monocytic, Acute / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D010419:Pentamidine / Q000627:therapeutic use*; D011020:Pneumonia, Pneumocystis / Q000276:immunology / Q000503:physiopathology / Q000517:prevention & control*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D012129:Respiratory Function Tests; D013997:Time Factors
D000336:Aerosols; D007166:Immunosuppressive Agents; D010419:Pentamidine