Corticosteroids improve survival of children with AIDS and Pneumocystis carinii pneumonia.
OBJECTIVE
To determine if corticosteroids administered in addition to antimicrobials improve survival in children with acquired immunodeficiency syndrome and severe Pneumocystis carinii pneumonia (PCP).


METHODS
Before-after, nonrandomized, case-comparison study.


METHODS
Pediatric intensive care unit of a tertiary care teaching hospital in Florida.


METHODS
Eleven children infected with the human immunodeficiency virus (HIV) with confirmed PCP.


METHODS
Infants with HIV infection and acute respiratory failure due to PCP were studied sequentially.


METHODS
The first seven infants were treated with antimicrobials alone while the next four received a 2-week course of methylprednisolone sodium succinate in addition to antimicrobials.


RESULTS
The two groups were similar with respect to age, route of HIV infection, stage of HIV disease, CD4 T-cell count, antiretroviral therapy, and respiratory parameters at intubation. All children treated with antimicrobials alone died while receiving mechanical ventilation. Survival of the children who received corticosteroid therapy was significantly improved (P < .05), and all were weaned from the ventilator.


CONCLUSIONS
Corticosteroids administered in addition to antimicrobials and supportive care improve the short-term survival of HIV-infected children who have acute respiratory failure due to PCP.
Sleasman
J W
JW
Department of Pediatrics, University of Florida College of Medicine, Gainesville.
Hemenway
C
C
Klein
A S
AS
Barrett
D J
DJ
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001784:Blood Gas Analysis; D016516:CD4-CD8 Ratio; D015496:CD4-Positive T-Lymphocytes; D004359:Drug Therapy, Combination; D005431:Florida / Q000453:epidemiology; D015658:HIV Infections / Q000097:blood / Q000145:classification / Q000150:complications*; D015497:HIV-1; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007770:L-Lactate Dehydrogenase / Q000097:blood; D007958:Leukocyte Count; D008776:Methylprednisolone Hemisuccinate / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D015996:Survival Rate; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D008776:Methylprednisolone Hemisuccinate; D007770:L-Lactate Dehydrogenase