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{Safrin1996ComparisonOT,
  title={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},
  author={Sharon Safrin and Dianne M. Finkelstein and Judith Feinberg and Peter T. Frame and Gail Simpson and Albert W. Wu and Tony W. Cheung and Ruy Soiero and Peter Hojczyk and John Black},
  journal={Annals of Internal Medicine},
  year={1996},
  volume={124},
  pages={792-802}
}
*For additional members of the ACTG 108 study group, see the Appendix. In 1994, 15 440 cases of Pneumocystis carinii pneumonia occurring in the United States were reported to the Centers for Disease Control and Prevention [1]. Thus, despite the advent of prophylactic agents to prevent this infection, the need for effective and nontoxic therapeutic regimens remains. Increased physician and patient awareness, along with improved methods of diagnosis, have made earlier institution of ambulatory… 

A meta-analysis of salvage therapy for Pneumocystis carinii pneumonia.

TLDR
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.

Low-dose trimethoprim-sulfamethoxazole for the treatment of Pneumocystis jirovecii pneumonia (LOW-TMP): protocol for a phase III randomised, placebo-controlled, dose-comparison trial

TLDR
A phase III randomised, placebo-controlled, trial to directly compare the efficacy and safety of low-dose TMP-SMX with the standard of care among patients with PJP, for a composite primary outcome of change of treatment, new mechanical ventilation, or death.

Toxicity and efficacy of daily vs. weekly dapsone for prevention of Pneumocystis carinii pneumonia in children infected with human immunodeficiency virus. ACTG 179 Study Team. AIDS Clinical Trials Group.

TLDR
Although a weekly dapsone regimen of 4 mg/kg produced less hematologic toxicity than a daily regimen of 2mg/kg, this advantage was offset by a trend toward higher breakthrough rates of PCP.

Clinical efficacy of first- and second-line treatments for HIV-associated Pneumocystis jirovecii pneumonia: a tri-centre cohort study.

TLDR
Clindamycin/primaquine appeared superior to pentamidine as second-line therapy for PCP in patients failing or developing toxicity with trimethoprim/sulfamethoxazole, and was associated with a greater risk of death when used as first- and second- line therapy for HIV-associated PCP.

Primaquine plus clindamycin as a promising salvage therapy for Pneumocystis jirovecii pneumonia: A retrospective analysis in Japanese patients.

Use of dapsone in the prevention and treatment of Pneumocystis carinii pneumonia: a review.

  • W. Hughes
  • Medicine, Biology
    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
  • 1998
TLDR
Dapsone is the most cost-effective prophylaxis currently available for PCP in AIDS patients and is as effective as aerosolized pentamidine or atovaquone but slightly less effective than TMP-SMZ.

Clindamycin with primaquine vs. Trimethoprim-sulfamethoxazole therapy for mild and moderately severe Pneumocystis carinii pneumonia in patients with AIDS: a multicenter, double-blind, randomized trial (CTN 004). CTN-PCP Study Group.

  • E. TomaAnona Thorne R. Therrien
  • Medicine, Biology
    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
  • 1998
TLDR
This trial confirms that Cm/Prq is a reasonable alternative therapy for mild and moderately severe PCP.

Reversal of Trimethoprim-Induced Antikaliuresis in an HIV Patient With Pneumocystis Pneumonia

TLDR
A case of a patient with severe PJP causing respiratory failure treated with high-dose trimethoprim-sulfamethaxazole who experienced hyperkalemia was successfully managed with a combination of fludrocortisone and furosemide allowing completion of antibiotic course.

On the Treatment of Pneumocystis jirovecii Pneumonia: Current Practice Based on Outdated Evidence

TLDR
The echinocandins are potential synergistic treatments in need of further investigation and Corticosteroids have a demonstrated role in hypoxemic patients with HIV but have yet to be studied in RCTs as an adjunctive therapy in non-HIV populations.
...

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Oral therapy for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. A controlled trial of trimethoprim-sulfamethoxazole versus trimethoprim-dapsone.

TLDR
In patients with AIDS, oral therapy with trimethoprim-sulfamethoxazole and with trimetrim-dapsone are equally effective for mild-to-moderate first episodes of P. carinii pneumonia, but with trimmedethopim- dapsone there are fewer serious adverse reactions than with trimETHoprim.

Clindamycin and primaquine therapy for mild-to-moderate episodes of Pneumocystis carinii pneumonia in patients with AIDS: AIDS Clinical Trials Group 044.

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TLDR
The combination of clindamycin and primaquine is an effective and well-tolerated therapy for mild-to-moderate pneumocystis pneumonia in patients with AIDS and Entirely oral therapy appears to be as effective as initial therapy with iv clind amycin.

Trimethoprim‐sulfamethoxazole versus pentamidine for Pneumocystis carinii pneumonia in AIDS patients: results of a large prospective randomized treatment trial

TLDR
TMP-SMX and pentamidine are of equivalent efficacy as initial therapies for PCP in patients with AIDS.

Dapsone-trimethoprim for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome.

TLDR
Oral dapsone-trimethoprim is at least as effective, seems to be better tolerated, and may have a lower frequency of serious side effects compared with trimethOPrim-sulfamethoxazole or pentamidine used to treat P. carinii pneumonia in similar patients.

Clindamycin/primaquine versus trimethoprim-sulfamethoxazole as primary therapy for Pneumocystis carinii pneumonia in AIDS: a randomized, double-blind pilot trial.

TLDR
The results of this pilot study show a trend toward less toxicity with clindamycin/primaquine than with TMP-SMZ, which must be confirmed by larger-scale clinical trials, which are also needed to better compare the efficacy of the two regimens.

Trimethoprim-sulfamethoxazole compared with pentamidine for treatment of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. A prospective, noncrossover study.

TLDR
Toxicity associated with the two standard treatments is rarely life-threatening and may be diminished if the trimethoprim-sulfamethoxazole dosage is modified by pharmacokinetic monitoring and the pentamidine dosage is reduced for nephrotoxicity.

Adjunctive folinic acid with trimethoprim-sulfamethoxazole for Pneumocystis carinii pneumonia in AIDS patients is associated with an increased risk of therapeutic failure and death.

TLDR
Folinic acid use was associated with a higher rate of both therapeutic failure and death and time to therapeutic failure was shorter and probability of death greater in patients receiving folinic acid, even when adjusted for baseline arterial oxygen pressure, serum lactate dehydrogenase, respiratory rate, CD4 cell count, and peak serum level of trimethoprim or sulfamethoxazole.

Trimethoprim-sulfamethoxazole or pentamidine for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. A prospective randomized trial.

TLDR
In patients with AIDS, trimethoprim-sulfamethoxazole and pentamidine do not have statistically significant differences in efficacy or frequency of adverse reactions, and the two groups did not differ significantly in the severity of pulmonary or systemic processes at enrollment.

Comparison of atovaquone (566C80) with trimethoprim-sulfamethoxazole to treat Pneumocystis carinii pneumonia in patients with AIDS.

TLDR
For the treatment of P. carinii pneumonia, atovaquone is less effective than trimethoprim-sulfamethoxazole, but it has fewer treatment-limiting adverse effects.

Dapsone, trimethoprim, and sulfamethoxazole plasma levels during treatment of Pneumocystis pneumonia in patients with the acquired immunodeficiency syndrome (AIDS). Evidence of drug interactions.

TLDR
A bidirectional drug interaction exists between dapsone and trimethoprim, resulting in higher concentrations of each in the presence of the other.