A meta-analysis of salvage therapy for Pneumocystis carinii pneumonia

Arch Intern Med. 2001 Jun 25;161(12):1529-33. doi: 10.1001/archinte.161.12.1529.

Abstract

Objective: To determine the relative efficacies of alternative antipneumocystis agents in human immunodeficiency virus (HIV)-infected patients with Pneumocystis carinii pneumonia unresponsive to primary drug treatment with a combination product of trimethoprim and sulfamethoxazole or parenteral pentamidine.

Methods: Meta-analysis of 27 published clinical drug trials, case series, and case reports involving P carinii pneumonia. Data extracted included underlying disease, primary antipneumocystis treatment, days of failed primary treatment, salvage regimen, use of systemic corticosteroids and antiretroviral drugs, and clinical outcome.

Results: In 497 patients with microbiologically confirmed P carinii pneumonia (456 with HIV or acquired immunodeficiency syndrome), initial antipneumocystis treatment failed and they therefore required alternative drug therapy. Failed regimens included trimethoprim-sulfamethoxazole (160 patients), intravenous pentamidine (63 patients), trimethoprim-sulfamethoxazole and/or pentamidine (258 patients), aerosolized pentamidine (6 patients), atovaquone (3 patients), dapsone (3 patients), a combination product of trimethoprim and dapsone (2 patients), and trimethoprim-sulfamethoxazole followed by a combination of clindamycin and primaquine phosphate (2 patients). Efficacies of salvage regimens were as follows: clindamycin-primaquine (42 to 44 [88%-92%] of 48 patients; P<10(-8)), atovaquone (4 [80%] of 5), eflornithine hydrochloride (40 [57%] of 70; P<.01), trimethoprim-sulfamethoxazole (27 [53%] of 51; P<.08), pentamidine (64 [39%] of 164), and trimetrexate (47 [30%] of 159).

Conclusion: The combination of clindamycin plus primaquine appears to be the most effective alternative treatment for patients with P carinii pneumonia who are unresponsive to conventional antipneumocystis agents.

Publication types

  • Meta-Analysis

MeSH terms

  • AIDS-Related Opportunistic Infections / diagnosis
  • AIDS-Related Opportunistic Infections / drug therapy*
  • AIDS-Related Opportunistic Infections / mortality
  • Adolescent
  • Adult
  • Aged
  • Child
  • Child, Preschool
  • Clindamycin / administration & dosage
  • Drug Therapy, Combination / administration & dosage*
  • Eflornithine / administration & dosage
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pentamidine / administration & dosage
  • Pneumonia, Pneumocystis / diagnosis
  • Pneumonia, Pneumocystis / drug therapy*
  • Pneumonia, Pneumocystis / mortality
  • Prognosis
  • Salvage Therapy*
  • Survival Rate
  • Treatment Outcome
  • Trimethoprim, Sulfamethoxazole Drug Combination / administration & dosage
  • Trimetrexate / administration & dosage

Substances

  • Clindamycin
  • Pentamidine
  • Trimethoprim, Sulfamethoxazole Drug Combination
  • Trimetrexate
  • Eflornithine