Summary
A prospective study was designed to evaluate the efficacy and effects on pulmonary function tests of weekly 600 mg aerosolised pentamidine as prophylaxis againstPneumocystis carinii pneumonia (PCP) amongst two groups of patients infected with the human immunodeficiency virus. Group 1 (primary prophylaxis) consisted of patients with either diseases indicative of AIDS other than PCP or whose absolute CD4 positive lymphocyte count was below 200/mm3, and Group 2 (secondary prophylaxis) comprised patients with previous proven episodes of PCP. Fifty-five patients (30-Group 1, 25-Group 2) were studied over a period of 36 months, and no patients reached a study end point of either relapse or death due to PCP after a mean duration of treatment of 14.9 months (range 9–36 months). There were no significant differences between the pulmonary function tests (forced expiratory volume in the first second, forced vital capacity and carbon monoxide diffusion capacity) performed at the start and end of the study on both groups of surviving patients. Ten patients (18%) reported coughing and eight patients (15%) were documented to have bronchoconstriction, which was found to be preventable by prior administration of disodiumcromoglycate. The results showed that weekly 600 mg aerosolised pentamidine is effective and well tolerated for primary and secondary prophylaxis against PCP without additional adverse effects. Further prospective randomized trials are needed to determine whether doses higher than the current recommended 300 mg monthly dosage of aerosolised pentamidine provide more efficacy before such an alternative prophylactic treatment is generally adopted for patients who cannot tolerate other systemic agents.
Zusammenfassung
In einer prospektiven Studie wurden die klinische Wirksamkeit einer wöchentlichen Applikation von 600 mg Pentamidin als Aerosol zur Prophylaxe gegen diePneumocystis carinii-Pneumonie (PCP) und der Einfluß auf die Lungenfunktionsparameter untersucht. Eingeschlossen in die Studie wurden zwei Gruppen von Patienten mit HIV-Infektion. Die Gruppe 1 (primäre Prophylaxe) bestand aus Patienten, bei denen Krankheiten aus dem AIDS-Symptomenkreis vorlagen oder die eine absolute CD4-Zellzahl unter 200/mm3 hatten, jedoch keine PCP. Gruppe 2 (sekundäre Prophylaxe) setzte sich aus Patienten zusammen, die bereits PCP-Episoden durchgemacht hatten. Über einen Zeitraum von 36 Monaten wurden 55 Patienten (30 Gruppe 1, 25 Gruppe 2) untersucht. Nach einer mittleren Behandlungsdauer von 14,9 Monaten (9 bis 36 Monaten) hatte keiner der Patienten ein Rezidiv erlitten oder war an PCP verstorben. Die Lungenfunktionsparameter (Ein-Sekundenwert, forcierte Vitalkapazität, CO-Diffusionskapazität) zeigten in den beiden Gruppen bei den überlebenden Patienten keine signifikanten Unterschiede in den zu Beginn und am Ende der Studie erhobenen Werten. Zehn Patienten (18%) berichteten über Husten und bei acht (15%) wurde eine Bronchokonstriktion nachgewiesen, die sich durch vorherige Inhalation von Disodiumcromoglykat vermeiden ließ. Die Ergebnisse zeigen, daß Pentamidin in einer Dosis von 600 mg als Aerosol einmal wöchentlich appliziert, eine effektive Prophylaxe der PCP darstellt, gut vertragen wird und keine zusätzlichen Nebenwirkungen verursacht. Es ist erforderlich, weitere randomisierte Studien durchzuführen, um festzustellen, ob höhere Dosen von Pentamidin in Aerosolform bessere Wirksamkeit bieten als die derzeit empfohlene Gabe von 300 mg einmal monatlich, bevor ein solches alternatives Prophylaxeregime generell für Patienten eingesetzt wird, die andere systemische Substanzen nicht tolerieren.
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Ong, E.L.C., Dunbar, E.M. & Mandal, B.K. Efficacy and effects on pulmonary function tests of weekly 600 mg aerosol pentamidine as prophylaxis againstPneumocystis carinii pneumonia. Infection 20, 136–139 (1992). https://doi.org/10.1007/BF01704600
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DOI: https://doi.org/10.1007/BF01704600