Martin M A, Cox P H, Beck K, Styer C M, Beall G N
Department of Medicine, Harbor-UCLA Medical Center, Torrance.
Arch Intern Med. 1992 Mar;152(3):523-8.
Pneumocystis carinii pneumonia (PCP) is a major cause of morbidity and the leading cause of death in patients with the acquired immunodeficiency syndrome. The prevention of the occurrence and recurrence of PCP is a cornerstone in the treatment of patients infected with the human immunodeficiency virus. There are few studies comparing PCP prophylactic regimens.
The efficacy of three regimens for prophylaxis against PCP was assessed in a retrospective chart review of 211 human immunodeficiency virus-infected patients at risk for the disease. Over the course of the 2-year study period, 133 patients were prescribed trimethoprim-sulfamethoxazole (one double-strength tablet twice a day, thrice weekly) for a mean of 7.4 months (range, 1 to 25 months). Seventy-seven patients received dapsone (50 mg daily) for a mean of 5.7 months (range, 1 to 23 months), and 125 patients received aerosolized pentamidine (300 mg via nebulizer once monthly) for a mean of 9.3 months (range, 1 to 21 months). The majority of patients (62%) received primary prophylaxis; 38% had one or more previous episodes of PCP; and 73% were receiving concomitant antiretroviral therapy.
Pneumocystis carinii pneumonia did not develop in any patient receiving trimethoprim-sulfamethoxazole in 981 patient-months. Five patients receiving dapsone for 437 patient-months and 17 patients receiving aerosolized pentamidine for 1166 patient-months developed PCP. Fifty-six percent of the trimethoprim-sulfamethoxazole group and 55% of the dapsone group changed drug due to adverse reactions, while only 2% in the aerosolized pentamidine group required drug change.
Despite its adverse reaction profile, trimethoprim-sulfamethoxazole is the most effective agent to prevent the occurrence and recurrence of PCP.
卡氏肺孢子虫肺炎（PCP）是获得性免疫缺陷综合征患者发病的主要原因及死亡的首要原因。预防PCP的发生和复发是治疗人类免疫缺陷病毒感染患者的基石。比较PCP预防方案的研究较少。
通过对211例有患该疾病风险的人类免疫缺陷病毒感染患者进行回顾性病历审查，评估三种预防PCP方案的疗效。在为期2年的研究期间，133例患者服用甲氧苄啶 - 磺胺甲恶唑（一片双倍剂量片剂，每日两次，每周三次），平均服用7.4个月（范围1至25个月）。77例患者服用氨苯砜（每日50毫克），平均服用5.7个月（范围1至23个月），125例患者接受雾化喷他脒（每月通过雾化器吸入300毫克），平均服用9.3个月（范围1至21个月）。大多数患者（62%）接受初级预防；38%曾有一次或多次PCP发作；73%正在接受抗逆转录病毒联合治疗。
在981患者 - 月中，接受甲氧苄啶 - 磺胺甲恶唑治疗的患者均未发生卡氏肺孢子虫肺炎。5例服用氨苯砜共437患者 - 月的患者及17例接受雾化喷他脒共1166患者 - 月的患者发生了PCP。甲氧苄啶 - 磺胺甲恶唑组56%和氨苯砜组55%的患者因不良反应更换药物，而雾化喷他脒组仅有2%的患者需要更换药物。
尽管有不良反应，甲氧苄啶 - 磺胺甲恶唑仍是预防PCP发生和复发最有效的药物。
