In Pneumocystis carinii pneumonia

It is used in the treatment of severe anaerobic infections caused by bacteroides and other anaerobes. It is also used in combination with aminoglycoside in the treatment of abdomen and GIT wounds, infections of female genital tract, pelvic abscesses, aspiration pneumonia and septic abortion. It is also used for prophylaxis of endocarditis. It is also used along with primaquine in Pneumocystis carinii pneumonia in AIDS patients and with pyrimethamine for toxoplasmosis. 

Answer C. In amebic dysentery caused by Entamoeba histolytica and GI infections with diarrhea ( back-packer s diarrhea ) due to Giardia lamblia, metronidazole is the drug of choice. Diloxanide is a backup drug for noninvasive intestinal amebiasis, but it has minimal activity in giardial infections. Quinacrine has effectiveness in giardiasis but not amebiasis. TMP-SMX has antiprotozoal effectiveness in Pneumocystis carinii pneumonia. Ciprofloxacin is devoid of antiprotozoal activity. 

Haley O. Pentamidine in Pneumocystis carinii pneumonia. Microlink Update 1987 3 1-4. 

Pentamidine Hemolymphatic stage of trypanosomiasis also used in Pneumocystis carinii pneumonia... 

Goa, K.L. and Campoh-Richards, D.M. (1987) Pentamidine isethionate. A review of its antiprotozoal activity, pharmacokinetic properties and therapeutic use in Pneumocystis carinii pneumonia. Drugs, 33, 242-258. 

AIDS (acquired immunodeficiency syndrome) is the final stage of disease caused by infection with HIV. In this stage, the vims infection has severely affected the immune system, causing a depletion of CD4+ T-helper cells. AIDS is characterized by the manifestation of typical diseases caused by opportunistic infections (Pneumocystis carinii pneumonia, CMV retinitis, candidiasis of the esophagus, cerebral toxoplasmosis), neurological manifestations, cachexia, or certain tumors (Kaposi sarcoma of the skin, B-cell lymphoma). 

Pneumocystis carinii pneumonia, a pneumonia seen in those with acquired immunodeficiency syndrome The mode of action of this drug is not fully understood. 

This drug is used cautiously in patients with peripheral vascular disease, neuropathy, chronic pancreatitis, or impaired liver function. Didanosine is a Pregnancy Category B drug and is used cautiously during pregnancy and lactation. There may be a decrease in the effectiveness of dapsone in preventing Pneumocystis carinii pneumonia when didanosine is administered with dapsone Use of didanosine with zalcitabine may cause additive neuropathy. Absorption of didanosine is decreased when it is administered with food. 

Note page numbers in italics refer to Pneumocystis carinii pneumonia amphoterocin B 114,7 7 5... 

Primaquine is also gametocytocidal and a single dose of 30-45 mg has been suggested to prevent transmission of falciparum malaria particularly in areas where there is a potential for reintroduction of malaria. Primaquine is also used in the treatment of Pneumocystis carinii pneumonia in AIDS patients in combinations with clindamycin [3]. 

The most common opportunistic diseases and their frequencies found before death in patients with AIDS between 1990 and 1994 were Pneumocystis carinii pneumonia (PCP), Mycobacterium avium complex, and cytomegalovirus disease. 

Lyles, R.H. et al., Prognostic value of plasma HIV RNA in the natural history of Pneumocystis carinii pneumonia, cytomegalovirus and Mycobacterium avium complex. Multicenter AIDS Cohort Study, AIDS, 13, 341, 1999. 

Dapsone (22 d -diaminodiphenyl sulfone) is an established antileprotic and antiinflammatory drug that is also effective in the therapy of Pneumocystis carinii pneumonia... 

Pneumocystis carinii pneumonia occurs in immunocompromised patients and it hence is a common cause of pneumonia in AIDS. High doses of co-trimoxazole are indicated for treatment of mild-to-moderate pneumocystis pneumonia. This condition should be treated by those experienced in its management as it can be fatal. 

Pneumocystis carinii pneumonia (POP) - Treatment in children and adults. 

Pneumocystis carinii pneumonia - Prophylaxis in individuals who are immunosuppressed and considered to be at increased risk. 

As an alternative therapy with concurrent leucovorin administration (leucovorin protection) for the treatment of moderate to severe Pneumocystis carinii pneumonia (PCP) in immunocompromised patients, including patients with acquired immunodeficiency syndrome (AIDS), who are intolerant of or refractory to TMP-SMZ therapy, or for whom TMP-SMZ is contraindicated. 

Antimicrobial prophylaxis Cases of Pneumocystis carinii pneumonia (PCP) have been reported in patients not receiving antimicrobial prophylaxis. Therefore, administer antimicrobial prophylaxis for PCP for 1 year following transplantation. Cytomegalovirus (CMV) prophylaxis is recommended for 3 months after transplantation, particularly for patients at increased risk for CMV disease. 

Desensitisation of sulfamethoxazole/trimethoprim can be done over a day as an in patient or over 10 days as an out patient (Table 13(a) and (b)). Then continue with the regimen for Pneumocystis carinii pneumonia prophylaxis. If the regimen, to be used... 

Because trimethoprim and sulfamethoxazole have their effects at different points in the folic acid synthetic pathway, a synergistic effect results when the two are administered together. The incidence of bacterial resistance to the combination is less than that observed when the drugs are used individually. Resistance is an increasing problem in a number of bacteria, but is especially problematic in the Enterobacteriaceae, against which the combination is used in AIDS patients for Pneumocystis carinii pneumonia prophylaxis. 

Dapsone, combined with other antUeprosy agents like rifampin and clofazimine, is used in the treatment of both multibacillary and paucibacillary M. leprae infections. Dapsone is also used in the treatment and prevention of Pneumocystis carinii pneumonia in AIDS patients who are allergic to or intolerant of trimethoprim-sulfamethoxazole. 

Glucocorticoids are also used in the treatment of a number of HIV-related disorders, including Pneumocystis carinii pneumonia, demyelinating peripheral neuropathies, tuberculous meningitis, and nephropathy. Glucocorticoids are used as adjunctive therapy in Pneumo cystitis carinii pneumonia to decrease the inflammatory response and allow time for antimicrobial agents to exert their effects. In patients who are immunocompromised because of HIV infection, adjunctive steroids may be less beneficial in promoting survival. 

Dermatitis herpetiformis PO Initially, 50 mg/day. May increase up to 300 mg/day Pneumocystis carinii pneumonia (PCP) PO 100 mg/day in combination with trimethoprim for 21 days. 

I Unlabeled Uses Prophylaxis for firsf episode and recurrence of Pneumocystis carinii pneumonia and Toxoplasma gondii in HlV-infecfed patients. 

The starting dose as well as dose adjustment in therapy are made according to guidelines fixed in the treatment protocols. For pneumocystis carinii pneumonia prophylaxis, trimethoprim-sulfamethoxazole is administered on three consecutive days per week, with the largest possible interval in reference to the weekly methotrexate application. This is done to account for the theoretical enhancement of the antifolic activity of methotrexate by co-administered trimethoprim-sulfamethoxazole (72,73). Because several reports have suggested an improved outcome with bedtime administration, 6-MP is commonly administered in the evening hours (74,75). Also, 6-MP should not be given in combination with milk because the xanthine oxidase (XO) activity contained in milk decreases the bioavailability of 6-MP (76,77,78). 

Indications IV Infusion Prophylaxis and treatment of Pneumocystis car/n/ pneumonia Shigellosis Severe or complicated urinary tract infections Tablets Prophylaxis and treatment of Pneumocystis carinii pneumonia Acute exacerbation of chronic bronchitis Urinary tract infections Travelers diarrhea in adults Shigellosis Acute otitis media ... 

Martos A, Podzamczer D, Martinez-Lacasa J, Rufi G, Santin M, Gudiol F. Steroids do not enhance the risk of developing tuberculosis or other AIDS-related diseases in HIV-infected patients treated for Pneumocystis carinii pneumonia. AIDS 1995 9(9) 1037 11. 

Sy ML, Chin TW, Nussbaum E. Pneumocystis carinii pneumonia associated with inhaled corticosteroids in an immunocompetent child with asthma. J Pediatr 1995 127(6) 1000-2. 

Bachelez H, Schremmer B, Cadranel J, Mouly F, Sarfati C, Agbalika F, Schlemmer B, Mayaud CM, Dubertret L. Fulminant Pneumocystis carinii pneumonia in 4 patients with dermatomyositis. Arch Intern Med 1997 157(13) 1501-3. 

Dunagan DP, Rubin BK, Fasano MB. Pneumocystis carinii pneumonia in a child receiving ACTH for infantile spasms. Pediatr Pulmonol 1999 27(4) 286-9. 

---