Once-weekly administration of dapsone/pyrimethamine vs. aerosolized pentamidine as combined prophylaxis for Pneumocystis carinii pneumonia and toxoplasmic encephalitis in human immunodeficiency virus-infected patients

Clin Infect Dis. 1995 Mar;20(3):531-41. doi: 10.1093/clinids/20.3.531.

Abstract

To evaluate combined prophylaxis for Pneumocystis carinii pneumonia (PCP) and toxoplasmic encephalitis, 533 patients with symptomatic human immunodeficiency virus infection and/or CD4 lymphocyte counts of < 200/microL were randomized to receive dapsone/pyrimethamine (200/75 mg once weekly) or aerosolized pentamidine (300 mg every 4 weeks). The median CD4 lymphocyte count was 110/microL; 47.5% were seropositive for toxoplasma antibodies. The median duration of follow-up was 483 days. In the intent-to-treat analysis, 12 cases of PCP and 14 of toxoplasmic encephalitis occurred in the dapsone/pyrimethamine group and 13 and 20 cases, respectively, in the aerosolized pentamidine group (adjusted relative risk for toxoplasmosis, 0.56; P = .10). However, only two of the 14 cases of toxoplasmic encephalitis in the dapsone/pyrimethamine group developed during actual treatment. The mortality among the two groups was similar. Dapsone/pyrimethamine was not tolerated by 30% of participants. A subanalysis of 240 matched, tolerant patients yielded a relative risk for toxoplasmosis of 0.21 (P = .014), a result favoring the use of dapsone/pyrimethamine. Dapsone/pyrimethamine was as effective as aerosolized pentamidine as prophylaxis for PCP and significantly reduced the incidence of toxoplasmic encephalitis among those participants who tolerated it.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS-Related Opportunistic Infections / epidemiology
  • AIDS-Related Opportunistic Infections / prevention & control*
  • Administration, Inhalation
  • Adult
  • Animals
  • Dapsone / administration & dosage
  • Dapsone / adverse effects
  • Dapsone / therapeutic use*
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Encephalitis / complications
  • Encephalitis / epidemiology
  • Encephalitis / parasitology
  • Encephalitis / prevention & control*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Pentamidine / administration & dosage
  • Pentamidine / adverse effects
  • Pentamidine / therapeutic use*
  • Pneumonia, Pneumocystis / complications
  • Pneumonia, Pneumocystis / epidemiology
  • Pneumonia, Pneumocystis / prevention & control*
  • Pyrimethamine / administration & dosage
  • Pyrimethamine / adverse effects
  • Pyrimethamine / therapeutic use*
  • Toxoplasmosis, Cerebral / complications
  • Toxoplasmosis, Cerebral / epidemiology
  • Toxoplasmosis, Cerebral / prevention & control*

Substances

  • Pentamidine
  • Dapsone
  • Pyrimethamine