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  • Title: Comparison of trimethoprim-sulfamethoxazole, dapsone, and pentamidine in the prophylaxis of Pneumocystis carinii pneumonia.
    Author: Warnock AC, Rimland D.
    Journal: Pharmacotherapy; 1996; 16(6):1030-8. PubMed ID: 8947975.
    Abstract:
    STUDY OBJECTIVE: To compare the incidence of Pneumocystis carinii pneumonia (PCP) in patients infected with the human immunodeficiency virus (HIV) receiving one of three prophylactic agents. DESIGN: Retrospective chart review. SETTING: A university-affiliated Department of Veterans' Affairs medical center HIV clinic. PATIENTS: All 200 HIV-infected patients enrolled in the clinic who were prescribed a PCP prophylactic drug during 18 months. INTERVENTIONS: Patients were administered oral trimethoprim-sulfamethoxazole (TMP-SMX) DS, oral dapsone, or aerosolized pentamidine in a heirarchic fashion. A subset of 110 patients received only one of the prophylaxis regimens for at least 6 months; they were examined separately for the purpose of statistical analysis. MEASUREMENTS AND MAIN RESULTS: One case of PCP was diagnosed in 1110 patient-months of oral TMP-SMX DS therapy, 6 in 418 patient-months of oral dapsone therapy, and 3 in 164 patient-months of aerosolized pentamidine therapy. In the subset population, the documented incidence of PCP was 0% among 71 TMP-SMX DS-treated patients, 16% among 25 dapsone-treated patients (p < 0.004), and 14% among 14 aerosolized pentamidine-treated patients (p < 0.03). For patients receiving primary prophylaxis, the incidence of PCP was 0% for 58 receiving TMP-SMX, 15% for 20 receiving dapsone (p = 0.015), and 17% for 6 receiving pentamidine (p = 0.094). CONCLUSION: We believe TMP-SMX DS was more effective than oral dapsone or aerosolized pentamidine in preventing PCP in these HIV-infected patients.
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