Pneumocystis carinii pneumonia treatment

AIDSTRIALS (AIDS Clinical Trials). The AIDSTRIALS database [80] provides information about AIDS-related studies of experimental treatments conducted under the FDA s investigational new drug (IND) regulations. AIDSTRIALS contains information about clinical trials of agents undergoing evaluation for use against AIDS, HIV infection, and AIDS-related opportunistic diseases such as Pneumocystis carinii pneumonia (PCP). Detailed information is supplied... 

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]. 

IMMUNODEFICIENCY WITH HYPER-IGM (HIGMl), AN IMMUNOGLOBULIN ISOTYPE SWITCH DEFECT CHARACTERIZED BY ELEVATED CONCENTRATIONS OF SERUM IGM AND DECREASED AMOUNTS OF ALL OTHER ISOTYPES. AFFECTED MALES PRESENT AT AN EARLY AGE (USUALLY WITHIN THE FIRST YEAR OF LIFE) RECURRENT BACTERIAL AND OPPORTUNISTIC INFECTIONS, INCLUDING PNEUMOCYSTIS CARINII PNEUMONIA AND INTRACTABLE DIARRHEA DUE TO CRYPTOSPORIDIUM INFECTION. DESPITE SUBSTITUTION TREATMENT WITH INTRAVENOUS IMMUNOGLOBULIN, THE OVERALL PROGNOSIS IS RATHER POOR, WITH A DEATH RATE OF ABOUT 10% BEFORE ADOLESCENCE. 

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. 

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. 

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. 

Unlabeled Uses Treatment of actinomycosis, babesiosis, erysipelas, malaria, otitis media, Pneumocystis carinii pneumonia, sinusitis, toxoplasmosis... 

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. 

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 ... 

Quan VA, Saunders BP, Hicks BH, Sladen GE. Cyclosporin treatment for ulcerative colitis complicated by fatal Pneumocystis carinii pneumonia. BMJ 1997 314(7077) 363 1. 

Pneumocystis carinii Pneumonia Pathogenesis, Diagnosis, and Treatment, edited by L. S. Young... 

Trimetrexate, CI-898, 96, showing antineoplastic activity in breast, head and neck cancer, and found to be active in treatment of Pneumocystis carinii pneumonia in AIDS patients89, has been 13C-, 15N- and 14C-labelled90 to facilitate the human and... 

Two other agents show promise in treatment of ocular toxoplasmosis. Atovaquone, primarily used for mild to moderate episodes of Pneumocystis carinii pneumonia, has been effective in small series of patients with toxoplasmosis. It appears to have activity against both tachy-zoites and tissue cysts. More recent studies on atovaquone in toxoplasmosis are limited to murine models, and no further reports on this drug therapy in humans have been published. Azithromycin, a macrolide antibiotic, is efficacious against T. gondii and can also kill tissue cysts. A randomized study of 46 patients compared the combinations of azithromycin plus pyrimethamine versus pyrimethamine plus sulfadiazine in treatment of ocular toxoplasmosis efficacy was similar, but the azithromycin/ pyrimethamine regimen caused less adverse effects. 

Impaired cell-mediated immunity leaves the host prey to many (opportunistic) infections including candidiasis, coccidioidomycosis, cryptosporidiosis, cytomegalovirus disease, herpes simplex, histoplasmosis, Pneumocystis carinii pneumonia, toxoplasmosis and tuberculosis (with multiply-resistant organisms). Treatment of these conditions is referred to elsewhere in this text for a comprehensive review of the antinticrobial prophylaxis of opportunistic infections in patients with HIV infection, readers are referred to Kovacs Masur 2000 New England Journal of Medicine 342 1416. 

Computational Chemistry Studies of Antifolate Drugs for Treatment of Pneumocystis carinii Pneumonia (PCP) in AIDS Patients Trimetrexate and Analogues. ... 

Hughes WT, LaFon SW, Scott JD, Masur H. Adverse events associated with trimethoprim-sulfamethoxazole and atovaquone during the treatment of AIDS-related Pneumocystis carinii pneumonia. J Infect Dis 1995 171(5) 1295-301. 

Rosenberg DM, McCarthy W, Slavinsky J, Chan CK, Montaner J, Braun J, Dohn MN, Caldwell PT. Atovaquone suspension for treatment of Pneumocystis carinii pneumonia in HIV-infected patients. AIDS 2001 15(2) 211-14. 

Oshitani N, Matsumoto T, Moriyama Y, Kudoh S, Hirata K, Kuroki T. Drug-induced pneumonitis caused by sulfamethoxazole, trimethoprim during treatment of Pneumocystis carinii pneumonia in a patient with refractory ulcerative colitis. J Gastroenterol 1998 33(4) 578-81. 

AUegra CJ, Chabner BA, Tuazon CU, Ogata-Arakaki D, Baird B, Drake JC, Simmons JT, Lack EE, Shelhamer JH, Bahs F, et al. Trimetrexate for the treatment of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome. N Engl J Med 1987 317(16) 978-85. 

Sensakovic JW, Suarez M, Perez G, Johnson ES, Smith LG. Pentamidine treatment of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. Association with acute renal failure and myoglobinuria. Archives of internal medicine. 

DeVita VT, Emmer M, Levine A, Jacobs B, Berard C. Pneumocystis carinii pneumonia successful diagnosis treatment of two patientswith associated malignant processes. The New England journal of medicine. 1969 Feb 6 280(6) 287-91. 

Balslev U, Berild D, Nielsen TL. Cardiac arrest during treatment of Pneumocystis carinii pneumonia with intravenous pentamidine isethionate. Scandinavian journal of infectious diseases. 1992 24(1) 111-2. 

It may also have ANTIPSYCHOTIC activity, dapiprazole hydrochloride dapiprazole. dapitant [inn] (RPR 100893) is a substituted isoindole, a TACHYKININ RECEPTOR ANTAGONIST, selective for the NK,-receptor subtype. It has potential as an ANTIMIGRAINE AGENT, dapsone [ban, inn, usan] is a sulphone with actions similar to SULPHONAMIDES and with ANTIBACTERIAL activity. It can be used as an antileprotic and for infective dermatitis herpetiformis. and is being investigated for the treatment and prevention of Pneumocystis carinii pneumonia (e.g. in AIDS), daptomycin [ban, inn, usan] is an (aminoglycoside) antibiotic. It has antibacterial properties. 

Immunosuppressed radiation victims may also be at risk for reactivation of cytomegalovirus (CMV) and Pneumocystis carinii pneumonia. In a limited casualty situation, if resources are available, clinicians should obtain CMV serology. In addition, patients should have a sensitive assay (antigen assessment or polymerase chain reaction test) every 2 weeks for 30 days postexposure, while those with documented previous CMV exposure should have the assay repeated until 100 days postexposure (2). Patients developing lymphopenia should have a CD4 cell count considered at 30 days postexposure. Those with a CD4 count below 0.2000 x 10 cells L" are at risk for Pneumocystis carinii pneumonia. Physicians should withhold trimethoprim-suha prophylaxis until the leukocyte count is above 3.0 x 10 cells L" or until the absolute neutrophil count is above 1.5 x 10 cells L . Atovaquone, dap-sone and aerosohzed pentamidine are alternative prophylactic agents. Patients should continue prophylactic treatment until the CD4 count reaches or exceeds 0.2000 X 10 cells L, which may occur over several months (2). 

Aerosolized Pentamidine for Treatment and Prophylaxis of Pneumocystis carinii Pneumonia in Patients with Acquired Immunodeficiency Syndrome... 

Figure 6 shows a photograph of three jet nebulizers. Numerous jet nebulizers are being marketed, and, indeed, some concern has been expressed about the nebulizer epidemic [140,141]. The first two nebulizers shown were selected because they are both used to deliver pentamidine to patients suffering from Pneumocystis carinii pneumonia, a secondary infection in AIDS. Of note, ultrasonic nebulizers have also been used for this purpose. Treatment of this particular disease is the most notable example of nebulizer therapy in recent years. Significantly, no other method of pentamidine aerosol generation is currently available. 

Pentamidine (Figure 16.7) and its analogs have been delivered to the lungs for the treatment of Pneumocystis carinii pneumonia, a secondary infection associated with acquired immune deficiency syndrome.33... 

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