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1 From the Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada
2 From The WVellesley Hospital, University of Toronto, Toronto, Canada
3 From the Departments of Medicine, The Toronto Hospital, University of Toronto, Toronto, Canada
4 From Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada
Study objective: To compare the effectiveness of a standard jet nebulizer, Respirgard II, and a standard ultrasonic nebulizer, Fisoneb, for the administration of aerosolized pentamidine (AP) as primary and secondary prophylaxis against Pneumocystis carinii pneumonia (PCP) in HIV-Infected individuals.
Design: A retrospective, nonrandomized, parallel group comparative study.
Setting: Patients were enrolled in a community-based AP program (APP) between May 1989 and April 1992 in Ontario, Canada. They received AP in either (1) a centralized treatment facility ("clinic") or (2) their attending physician's office or regionalized centers ("nonclinic"). Clinic administration of pentamidine was via Fisoneb; nonclinic via Respirgard II.
Patients: The study group comprised of 1,762 HIV-infected individuals requiring AP for either primary (CD4 <200/mm3) or secondary PCP prophylaxis. Of these, 1,151 used Fisoneb (clinic) and 611 used Respirgard II (nonclinic).
Results: In the primary prophylaxis group, 41 of the 892 patients using Fisoneb (4.6%; mean follow-up, 18 months) compared with 16 of 435 patients using Respirgard II (3.7%; mean follow-up, 14.6 months) developed PCP (p=0.44). A total of 28 of 259 (10.8%; mean follow-up, 15.3 months) patients using Fisoneb for secondary prophylaxis compared with 11 of 176 (6.3%; mean follow-up, 14.4 months) patients using Respirgard II for secondary prophylaxis developed PCP (p=0.1).
Conclusions: Despite the difference in dosage (120 mg/mo vs 300 mg/mo), type of nebulizer (ultrasonic vs jet), and frequency of administration (twice vs once monthly), the results of this study indicate that both regimens of AP provide comparable protection against PCP. This study further supports the effectiveness of AP as a solid second-line prophylaxis for HIV-infected individuals who are intolerant to trimethoprim/sulfamethoxazole or dapsone.
Key Words: HIV infection • Pneumnocystis carinii • prevention
Submitted on August 8, 1965
This article has been cited by other articles:
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  J. Obaji, L. R. Lee-Pack, C. Gutierrez, and C. K.N. Chan The Pulmonary Effects of Long-term Exposure to Aerosol Pentamidine: A 5-Year Surveillance Study in HIV-Infected Patients Chest, June 1, 2003; 123(6): 1983 - 1987. [Abstract] [Full Text] [PDF]
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 S. Grkovic, M. H. Brown, and R. A. Skurray Regulation of Bacterial Drug Export Systems Microbiol. Mol. Biol. Rev., December 1, 2002; 66(4): 671 - 701. [Abstract] [Full Text] [PDF]
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C. C-Y Wei, S. Gardner, A. Rachlis, L. L. Pack, and C. K. N. Chan Risk Factors for Prophylaxis Failure in Patients Receiving Aerosol Pentamidine for Pneumocystis carinii Pneumonia Prophylaxis Chest, May 1, 2001; 119(5): 1427 - 1433. [Abstract] [Full Text] [PDF]
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