Clindamycin/primaquine as prophylaxis for Pneumocystis carinii pneumonia.
The records of 206 patients with advanced infection due to human immunodeficiency virus type 1 who were receiving prophylaxis with clindamycin/primaquine (C/P), trimethoprim-sulfamethoxazole (TMP-SMZ), or dapsone to prevent Pneumocystis carinii pneumonia (PCP) were retrospectively examined. Two hundred sixty-two patient-years of prophylaxis were accrued (176.2 of TMP-SMZ, 63.4 of dapsone, and 22.8 of C/P). The rates of PCP in the TMP-SMZ, dapsone, and C/P groups were 3.4, 11.0, and 30.7 per 100 patient-years, respectively. Pairwise comparisons showed C/P to be less effective than TMP-SMZ (relative risk [RR], 9.02; 95% confidence interval [CI], 3.03-26.83). A similar trend was apparent for C/P vs. dapsone (RR, 2.78; 95% CI, 0.98-7.93). When only those receiving primary prophylaxis were analyzed, C/P recipients remained at greater risk than TMP-SMZ recipients (RR, 13.19; 95% CI, 3.54-49.12) and dapsone recipients (RR, 3.85; 95% CI, 1.12-13.31). Failure of C/P prophylaxis could be due, at least in part, to underdosing (clindamycin, 300 mg/d; primaquine, 15 mg/d). C/P recipients had more nonspecific diarrhea than did TMP-SMZ recipients (RR, 2.99; 95% CI, 1.61-5.55).
Barber
B A
BA
Department of Internal Medicine, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina 27157-1042, USA.
Pegram
P S
PS
High
K P
KP
D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000009:adverse effects / Q000627:therapeutic use; D000962:Antimalarials / Q000009:adverse effects / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002981:Clindamycin / Q000009:adverse effects / Q000627:therapeutic use*; D003622:Dapsone / Q000009:adverse effects / Q000627:therapeutic use; D003967:Diarrhea / Q000150:complications / Q000175:diagnosis / Q000382:microbiology; D004342:Drug Hypersensitivity; D004359:Drug Therapy, Combination; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications; D015658:HIV Infections / Q000150:complications*; D015497:HIV-1; D006402:Hematologic Diseases / Q000150:complications; D006801:Humans; D008297:Male; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy* / Q000517:prevention & control*; D011319:Primaquine / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D000962:Antimalarials; D002981:Clindamycin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D003622:Dapsone; D011319:Primaquine