Goodwin S D
Division of Pharmacy Practice, School of Pharmacy, University of Colorado Health Sciences Center, Denver 80262.
Pharmacotherapy. 1993 Nov-Dec;13(6):640-6.
Pneumocystis carinii pneumonia (PCP) is the most common opportunistic infection in adults and children infected with the human immunodeficiency virus (HIV). Without prophylaxis, half of all these children will develop PCP at sometime during their illness. The disease is associated with high mortality and a poor prognosis for long-term survival in this patient population. In infants and young children, PCP may be a primary infection, compared with reactivation of a latent infection that is usually the case in older children and adults. Clinical features, radiographic findings and diagnostic strategies are similar in children and adults. Although alternative agents are being investigated, trimethoprimsulfamethoxazole (TMP-SMX) and pentamidine remain the standard therapeutic agents. Insufficient data are available to recommend routine adjunctive corticosteroids in children with acquired immunodeficiency syndrome (AIDS), PCP, and significant respiratory disease. Prophylaxis against PCP occurrence or recurrence is indicated for HIV-infected children and infants under 1 year of age, children with less than 20% T4 helper lymphocytes, those meeting age-related Centers for Disease Control (CDC) guidelines for prophylaxis, and those with a history of suspected or documented PCP. The CDC recommends intermittent TMP-SMX for PCP prophylaxis in children with AIDS.
卡氏肺孢子虫肺炎（PCP）是感染人类免疫缺陷病毒（HIV）的成人和儿童中最常见的机会性感染。若不进行预防，所有这些儿童中有一半会在患病期间的某个时候患上PCP。该疾病与高死亡率相关，且在这一患者群体中远期生存预后较差。在婴幼儿中，PCP可能是原发性感染，而在大龄儿童和成人中通常是潜伏感染的重新激活。儿童和成人的临床特征、影像学表现及诊断策略相似。尽管正在研究替代药物，但甲氧苄啶-磺胺甲恶唑（TMP-SMX）和喷他脒仍是标准治疗药物。对于患有获得性免疫缺陷综合征（AIDS）、PCP且有严重呼吸系统疾病的儿童，尚无足够数据推荐常规使用辅助性皮质类固醇。对于1岁以下的HIV感染儿童和婴儿、T4辅助淋巴细胞低于20% 的儿童、符合疾病控制中心（CDC）年龄相关预防指南的儿童以及有疑似或确诊PCP病史的儿童，均需预防PCP的发生或复发。CDC推荐对患有AIDS的儿童间歇性使用TMP-SMX预防PCP。
