Orcutt T A, Godwin C R, Pizzo P A, Ognibene F P
Critical Care Medicine Department, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20892.
Pediatr Infect Dis J. 1992 Apr;11(4):290-4.
Aerosolized pentamidine has been recommended as an alternative mode of antipneumocystis prophylaxis in human immunodeficiency virus-infected children with trimethoprim-sulfamethoxazole intolerance. However, there have been no definitive data concerning the most appropriate dose and the tolerance of aerosolized pentamidine in children. In the present study, we assessed the tolerance of aerosolized pentamidine in older children using a regimen similar to the one recommended in adults. A 300-mg dose of pentamidine was administered to our human immunodeficiency virus-infected patients monthly using the Respirgard II nebulizer. Patients were assessed for their heart rate, respiratory rate, breath sounds and oxygen saturations during and after pentamidine aerosolization. During a 21-month period (August, 1989, to May, 1991), 22 patients (mean age, 9.8 +/- 0.6 years; range, 3 to 15 years) received a total of 185 treatments. Patients complained of either a bitter taste (16 of 22) or developed short periods of coughing (15 of 22) during the aerosol. Five patients developed reversible bronchospasm requiring bronchodilators; no patients developed oxygen desaturation. None of the patients developed Pneumocystis carinii pneumonia during the limited protocol follow-up (mean, 9.8 months). Thus aerosolized pentamidine for antipneumocystis prophylaxis is well-tolerated in older children. However, more comprehensive investigations of efficacy are indicated.
对于对甲氧苄啶 - 磺胺甲噁唑不耐受的人类免疫缺陷病毒感染儿童，雾化喷他脒已被推荐作为预防肺孢子菌肺炎的替代方式。然而，关于儿童雾化喷他脒的最合适剂量和耐受性，尚无确切数据。在本研究中，我们使用与成人推荐方案相似的方案，评估了大龄儿童对雾化喷他脒的耐受性。使用Respirgard II雾化器，每月给我们的人类免疫缺陷病毒感染患者给予300毫克喷他脒。在喷他脒雾化期间及之后，对患者的心率、呼吸频率、呼吸音和血氧饱和度进行评估。在21个月期间（1989年8月至1991年5月），22例患者（平均年龄9.8±0.6岁；范围3至15岁）共接受了185次治疗。患者在雾化期间抱怨有苦味（22例中的16例）或出现短时间咳嗽（22例中的15例）。5例患者出现可逆性支气管痉挛，需要使用支气管扩张剂；没有患者出现氧饱和度降低。在有限的方案随访期间（平均9.8个月），没有患者发生卡氏肺孢子虫肺炎。因此，雾化喷他脒用于预防肺孢子菌肺炎在大龄儿童中耐受性良好。然而，需要进行更全面的疗效研究。
