[Corticosteroid treatment of patients with AIDS and severe Pneumocystis carinii pneumonia. A European multicenter study. Danish-Dutch AIDS Study Group].
Fifty-nine HIV-1 infected patients with a microscopically proven first episode of moderate to severe Pneumocystis carinii pneumonia (PCP) were enrolled into a randomized European multicenter study. The effect of adjunctive corticosteroid (CS) therapy was assessed on: 1) survival to discharge, 2) need for mechanical ventilation (MV) and 3) survival at day 90. CS was given within 24 hours of standard therapy as intravenous methylprednisolone 2 mg/kg bodyweight daily for ten days. All patients received cotrimoxazole as standard treatment. Inclusion criteria were a PaO2 < 9.0 kPa (67.5 mmHg) and/or a PaCO2 < 4.0 kPa (30.0 mmHg). During the acute episode of PCP nine (31%) of the 29 control patients died versus three (10%) of the 30 CS patients; p = 0.01. Mechanical ventilation was necessary in 15 patients; 12 (41%) in the control group and three (10%) in the KS group; p = 0.01. The 90-day survival was 69% in patients receiving cotrimoxazole alone versus 87% in patients receiving adjunctive KS; p = 0.07. Based on these data we conclude that adjunctive CS therapy for moderate to severe PCP in AIDS-patients reduces the acute mortality and the need for mechanical ventilation.
Nielsen
T L
TL
Infektionsmedicinsk afdeling, Hvidovre Hospital, København.
Eeftinck Schattenkerk
J K
JK
Jensen
B N
BN
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D000328:Adult; D003718:Denmark; D004341:Drug Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D009426:Netherlands; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies
D008775:Methylprednisolone
Kortikosteroid til AIDS-patienter med svaer Pneumocystis carinii pneumoni. Et europoeisk multicenterstudie. Dansk-hollandske AIDS-Studiegruppe.