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CDC HIV/AIDS/Viral Hepatitis/STD/TB Prevention News Update
PCP Therapy: Aerosolized Pentamidine vs. TMP-SMX

June 7, 1995
AIDS Clinical Care (06/95) Vol. 7, No. 6, P. 51

As part of a randomized study of treatments for Pneumocystis carinii pneumonia (PCP), researchers assigned 367 patients to 21 days of treatment with either aerosolized pentamidine or trimethoprim-sulfamethoxazole (TMP-SMX). Each group also received placebos imitating the opposite treatment. After 35 days, mortality in the TMP-SMX group was higher, but not enough to be statistically significant. However, significantly more TMP-SMX recipients changed therapy because of toxicity, while significantly fewer did so because of slow clinical response. The greatest difference in response was among patients with an initial alveolar-arterial oxygen gradient greater than 30 mm Hg. After six months, there were fewer PCP recurrences with TMP-SMX, but the survival rates for the two drugs were almost identical. The researchers concluded that TMP-SMX appears to lead to more rapid improvements in oxygenation, more treatment successes, and fewer relapses than aerosolized pentamidine, but they are not sure why it did not also reduce mortality.