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Title

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

Authors
Opravil, Milos
Lazzarin, Adriano
Rüttimann, Sigmund
Iten, Anne
von Overbeck, Jan
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Published in Clinical Infectious Diseases. 1995, vol. 20, no. 3, p. 531-541
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.
Keywords AIDS-Related Opportunistic Infections/epidemiology/ prevention & controlAdministration, InhalationAdultAnimalsDapsone/administration & dosage/adverse effects/ therapeutic useDrug Administration ScheduleDrug Therapy, CombinationEncephalitis/complications/epidemiology/parasitology/ prevention & controlFemaleFollow-Up StudiesHumansMalePentamidine/administration & dosage/adverse effects/ therapeutic usePneumonia, Pneumocystis/complications/epidemiology/ prevention & controlPyrimethamine/administration & dosage/adverse effects/ therapeutic useToxoplasmosis, Cerebral/complications/epidemiology/ prevention & control
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PMID: 7756472
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Other version: http://www.jstor.org/stable/pdfplus/4458377.pdf
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OPRAVIL, Milos et al. 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. In: Clinical Infectious Diseases, 1995, vol. 20, n° 3, p. 531-541. https://archive-ouverte.unige.ch/unige:7452

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Deposited on : 2010-06-21

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