Options in the management of pneumonia caused by Pneumocystis carinii in patients with acquired immune deficiency syndrome and intolerance to trimethoprim/sulfamethoxazole.
The increased resistance, intolerance, or allergy to trimethoprim/sulfamethoxazole (TMP/SMX) has brought much attention to alternative treatment of pneumonia caused by Pneumocystis carinii (PCP). Pentamidine is considered when there is documented allergy or intolerance to TMP/SMX. Similarly, either dapsone/trimethoprim or clindamycin/primaquine is effective in the treatment of mild to moderate PCP, but both regimens are contraindicated in glucose 6-phosphate dehydrogenase (G6PD) deficiency. For this purpose, atovaquone should be used in patients who are deficient in G6PD or who are unable to be on TMP/SMX or pentamidine. On the other hand, in severe disease, adjunctive corticosteroids can enhance the efficacy of either TMP/SMX or pentamidine. If these therapies yield no response, trimetrexate with leucovorin has been approved as initial and salvage therapy in severe PCP. We review alternative treatment to TMP/SMX and propose ideal and practical therapeutic and prophylactic guidelines in the treatment and prevention of PCP.
Korraa
H
H
Department of Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, 79106, USA.
Saadeh
C
C
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy*; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D053626:Atovaquone; D002981:Clindamycin / Q000627:therapeutic use; D003622:Dapsone / Q000627:therapeutic use; D004338:Drug Combinations; D004342:Drug Hypersensitivity; D004352:Drug Resistance, Microbial; D006801:Humans; D002955:Leucovorin / Q000627:therapeutic use; D009285:Naphthoquinones / Q000627:therapeutic use; D010419:Pentamidine / Q000627:therapeutic use; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy*; D011319:Primaquine / Q000627:therapeutic use; D014295:Trimethoprim / Q000627:therapeutic use; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D016597:Trimetrexate / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D000890:Anti-Infective Agents; D000935:Antifungal Agents; D004338:Drug Combinations; D009285:Naphthoquinones; D002981:Clindamycin; D010419:Pentamidine; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D003622:Dapsone; D014295:Trimethoprim; D011319:Primaquine; D002955:Leucovorin; D016597:Trimetrexate; D053626:Atovaquone