Successful desensitization to dapsone for Pneumocystis carinii prophylaxis in an HIV-positive patient.
OBJECTIVE
To report a case of successful desensitization to dapsone for Pneumocystis carinii pneumonia (PCP) prophylaxis in a patient unable to tolerate trimethoprim/sulfamethoxazole (TMP/SMX) desensitization or dapsone at standard doses.


METHODS
A 37-year-old HIV-positive African-American man was treated for pneumonia with TMP/SMX and then continued on the drug for PCP prophylaxis. After experiencing a pruritic maculopapular rash with TMP/SMX, both at standard doses and after attempting a desensitization regimen to the drug, he was started on dapsone for PCP prophylaxis. He experienced a rash and fever after taking dapsone at standard PCP prophylactic doses. At this time, an 18-day oral dapsone rechallenge by dose escalation was attempted, and it was well tolerated.


CONCLUSIONS
This case suggests that utilization of a dapsone desensitization regimen may permit a viable treatment option in patients previously thought to be intolerant to the agent. More regimens of this type should be attempted and the results published, using both dapsone and TMP/SMX, so that standard desensitization treatment guidelines may eventually be adopted.
Cook
D E
DE
Department of Pharmacy Practice, University of Washington School of Pharmacy, Seattle, USA.
Kossey
J L
JL
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000517:prevention & control*; D000328:Adult; D000890:Anti-Infective Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003622:Dapsone / Q000627:therapeutic use*; D003888:Desensitization, Immunologic; D004342:Drug Hypersensitivity / Q000628:therapy; D006679:HIV Seropositivity; D006801:Humans; D008297:Male; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy / Q000517:prevention & control*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects*
D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D003622:Dapsone