Efficacy and safety of dapsone prophylaxis against Pneumocystis carinii pneumonia in human immunodeficiency virus-infected children.

Dapsone (4,4'-diaminodiphenylsulfone) is recommended as an alternative agent for prophylaxis against Pneumocystis carinii in children with human immunodeficiency virus infection. We reviewed our experience over the past 100 months with 20 children (age range, 2 months to 13 years) who received dapsone and examined the safety and efficacy of this regimen. Dapsone was taken for an average of 7.33 months/patient or a total of 4410 days by those children in whom safety could be assessed. Three of the 20 patients had an adverse reaction to dapsone. One had mild elevation of blood methemoglobin values (5.6%) and transient elevation of serum transaminases that resolved without discontinuing drug. The other two developed allergic skin rashes which necessitated discontinuation. Efficacy of dapsone in preventing P. carinii pneumonia (PCP) was assessed in 16 children at high risk for developing PCP (defined by CD4 counts or prior PCP infection). These 16 children took dapsone for an average of 6.88 months and a total of 3300 days. Two of the 16 high risk children, one who had had a previous P. carinii pneumonia, developed PCP while taking dapsone. Both had CD4 counts < or = 200 cells/mm3 and were taking dapsone for > or = 12 months before developing PCP. Dapsone is well-tolerated in children and appears to be as effective in preventing PCP in children with human immunodeficiency virus infection as it is in adults.