Comparison of three regimens for treatment of mild to moderate Pneumocystis carinii pneumonia in patients with AIDS: a double blind, randomized trial of oral trimethoprim-sulfamethoxazole, dapsone-trimethoprim, and clindamycin-primaquine

Article Abstract:

Oral treatment with trimethoprim-sulfamethoxazole, dapsone-trimethoprim, or clindamycin-primaquine all seem to produce equally good outcomes and similar complication rates in AIDS patients with Pneumocystis (P.) carinii pneumonia. Researchers randomly assigned 181 AIDS patients over age 13 with mild to moderate P. carinii pneumonia to treatment with one of three drug combinations. About half of patients in each group completed a full course of therapy. At seven days, patients receiving clindamycin-primaquine reported the highest health status scores, but differences between groups narrowed by day 21. Dose-limiting side effects occurred in 24% of patients receiving dapsone-trimethoprim, 33% of patients receiving clindamycin-primaquine, and 36% of patients receiving trimethoprim-sulfamethoxazole. Rash was the most common complication that limited dose, and it occurred in 10% of dapsone-trimethoprim group, half the rate of the other two regimens. Trimethoprim-sulfamethoxazole was most likely to cause liver complications and clindamycin-primaquine to cause blood cell complications.

Evaluation, Dapsone, Co-trimoxazole, Trimethoprim-sulfamethoxazole (Drug combination), Trimethoprim, Clindamycin, Primaquine

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Patterns of opportunistic infections in patients with HIV infection

Article Abstract:

HIV-infected patients who have had an opportunistic infection are at risk of another one regardless of their CD4 cell count. Researchers analyzed the development of certain opportunistic infections in 1,530 HIV-infected patients. The infections were Pneumocystis carinii pneumonia (PCP), any type of systemic mycosis, or fungal infection (MYCOS), Mycobacterium avium complex (MAC) and cytomegalovirus infection (CMV). Thirty-six percent of the patients developed one or more opportunistic infection during the study. Once a patient developed PCP or MYCOS, the risk of developing another opportunistic infection was greater than the risk of dying. Following PCP, the risk of developing MAC or CMV was five times greater than in the absence of PCP. The risk of recurrent PCP or MYCOS was two to three times higher. Patients with MAC were likely to develop CMV and vice versa. MYCOS often led to MAC or CMV but not PCP.

Complications and side effects, Risk factors, Opportunistic infections

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Escalating multiple-dose safety and tolerance study of oral WR 6026 in HIV-infected subjects: AIDS Clinical Trials Group 173

Article Abstract:

The drug WR 6026 appears to be safe when given to HIV patients to treat Pneumocystis carinii pneumonia. The drug is related to a drug called primaquine that is used against malaria. Researchers gave the drug to 49 HIV patients, 25 of whom had a CD4 T cell count below 200 and 12 of whom had a count below 100. The patients took the drug for 21 days. The maximum dose that could be used without causing side effects was 120 milligrams per day. This study only evaluated the safety of the drug, not its effectiveness in treating Pneumocystis carinii pneumonia.

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