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Options in the management of pneumonia caused by Pneumocystis carinii in patients with acquired immune deficiency syndrome and intolerance to trimethoprim/sulfamethoxazole Korraa H; Saadeh CSouth Med J 1996[Mar]; 89 (3): 272-7The increased resistance, intolerance, or allergy to trimethoprim/sulfamethoxazole (TMP/SMX) has brought much attention to alternative treatment of pneumonia caused by Pneumocystis carinii (PCP). Pentamidine is considered when there is documented allergy or intolerance to TMP/SMX. Similarly, either dapsone/trimethoprim or clindamycin/primaquine is effective in the treatment of mild to moderate PCP, but both regimens are contraindicated in glucose 6-phosphate dehydrogenase (G6PD) deficiency. For this purpose, atovaquone should be used in patients who are deficient in G6PD or who are unable to be on TMP/SMX or pentamidine. On the other hand, in severe disease, adjunctive corticosteroids can enhance the efficacy of either TMP/SMX or pentamidine. If these therapies yield no response, trimetrexate with leucovorin has been approved as initial and salvage therapy in severe PCP. We review alternative treatment to TMP/SMX and propose ideal and practical therapeutic and prophylactic guidelines in the treatment and prevention of PCP.|AIDS-Related Opportunistic Infections/*drug therapy[MESH]|Adrenal Cortex Hormones/therapeutic use[MESH]|Anti-Infective Agents/adverse effects/*therapeutic use[MESH]|Antifungal Agents/adverse effects/*therapeutic use[MESH]|Atovaquone[MESH]|Clindamycin/therapeutic use[MESH]|Dapsone/therapeutic use[MESH]|Drug Combinations[MESH]|Drug Hypersensitivity[MESH]|Drug Resistance, Microbial[MESH]|Humans[MESH]|Leucovorin/therapeutic use[MESH]|Naphthoquinones/therapeutic use[MESH]|Pentamidine/therapeutic use[MESH]|Pneumonia, Pneumocystis/*drug therapy[MESH]|Primaquine/therapeutic use[MESH]|Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use[MESH]|Trimethoprim/therapeutic use[MESH]|Trimetrexate/therapeutic use[MESH] |
