TITLE

PNEUMOCYSTIS CARINII PNEUMONIA CHEMOPROPHYLAXIS IN HIV+ PATIENTS IN GLASGOW: AN AUDIT

AUTHOR(S)
Wardle, D.M.; Kennedy, D.
PUB. DATE
June 2003
SOURCE
Sexually Transmitted Infections;Jun2003 Supplement 1, Vol. 79, pA22
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Introduction: We audited chemoprophylactic use against Pneumocystis carinii pneumonia (PCP) in our HIV+ patients using US Public Health Service and Infectious Diseases Society of America USPHS/IDSA guidelines as a standard in the absence of definitive UK guidelines. Methods: Criteria for patients on prophylaxis including most recent CD4 count, percentage, method of primary or secondary prophylaxis, and changes to initial choice were obtained from casenotes. The time interval since achieving the threshold of CD4 count >200 cells/µl and CD4 percentage ≥14% for at least three months were calculated. Results: 97 patients received PCP prophylaxis; 71% primary and 29% secondary. 79% met the standards of the US guidelines. One patient had primary prophylaxis discontinued despite the guidelines. In total, prophylaxis was extended beyond the discontinuation threshold for 268 months. The US recommended regime is co-trimoxazole 960 mg daily and was prescribed to 29% of our patients, with a further 55% on lower or less frequent dosing. Alternative regimes included monthly nebulised pentamidine (13%) and daily dapsone (3%). Prophylaxis had been changed in 37 cases, 17 with a documented reason. An adverse event with co-trimoxazole was documented in 14 cases and 2 were re-challenged. Three patients developed primary PCP with CD4 counts >200 cells/µl; 475 (16%), 449 (10%), and 291 (5%), respectively. Conclusion: The majority (79%) of patients receiving PCP prophylaxis met the standard. Up to 70% of patients experiencing adverse events with co-trimoxazole can be successfully re-challenged. This should be encouraged as co-trimoxazole 960 mg daily can confer cross protection against Toxoplasma gondii, 2 (14%) of our patients were successfully re-challenged. Continuation beyond the recommended guidelines adds little to prevention, cessation can simplify treatment, lower costs, reduce toxicity, and may facilitate adherence to antiretrovirals.
ACCESSION #
10218814

 

Related Articles

  • PCP prophylaxis with use of corticosteroids by neurologists. Kelly, Dearbhla M.; Cronin, Simon // Practical Neurology (BMJ Publishing Group);Apr2014, Vol. 14 Issue 2, p74 

    Pneumocystis jirovecii pneumonia (PCP) is increasingly reported in patients without HIV. Corticosteroids are a major risk factor, with up to 90% of patients receiving corticosteroid treatment prior to the development of PCP. In view of this, many specialties now prescribe PCP prophylaxis to...

  • A Randomized Trial of Daily and Thrice-Weekly Trimethoprim-Sulfamethoxazole for the Prevention of Pneumocystis carinii Pneumonia in Human Immunodeficiency Virus-Infected Persons. El-Sadr, Wafaa M.; Luskin-Hawk, Roberta; Yurik, Teresa McCabe; Walker, Janice; Abrams, Donald; John, Stanley L.; Sherer, Renslow; Crane, Lawrence; Labriola, Ann; Caras, Susan; Pulling, Chris; Hafner, Richard // Clinical Infectious Diseases;10/1/1999, Vol. 29 Issue 4, p775 

    Presents a study which investigated the efficacy of daily versus thrice-weekly trimethoprim-sulfamethoxazole for prevention of Pneumocystis carinii pneumonia in HIV-infected persons. Background of the drug; Materials and methods used; Results and discussion.

  • Diagnostic and Therapeutic Technology Assessment (DATTA).  // JAMA: Journal of the American Medical Association;5/9/90, Vol. 263 Issue 18, p2510 

    Discusses the use of aerosolized pentamidine in preventing recurrent Pneumocystis carnii infection in HIV-positive patients. Mechanism of action of the drug; Effectiveness and safety of the drug; Method of delivery of aerosolized pentamidine.

  • Prisoners' Knowledge and Attitude toward Prophylactic Treatment Therapy. Braithwaite, Ronald; Stephens, Torrance T. // AIDS Patient Care & STDs;Sep98, Vol. 12 Issue 9, p697 

    Focuses on HIV-positive inmates attitude and knowledge towards pneumocystis carinii pneumonia (PCP) prophylaxis therapy. Factors which contributed to prohibited inmates' compliance with PCP; Examination of nine knowledge variables; Identification of inmates' attitudinal concerns on treatment of...

  • Atovaquone and Dapsone for PCP Prophylaxis. Kirchner, Jeffrey T. // American Family Physician;4/15/1999, Vol. 59 Issue 8, p2334 

    Presents an abstract of the study `Atovaquone compared with dapsone for the prevention of Pneumocystis carinii pneumonia in patients with HIV infection who cannot tolerate trimethoprim, sulfonamides, or both,' by W. M. El-Sadr et al, from `New England Journal of Medicine' dated December 24, 1998.

  • HIV+ patients still need PCP prophylaxis.  // AIDS Alert;Jul2007, Vol. 22 Issue 7, p80 

    The article reports that prophylaxis against pneumocystic carinii pneumonia (PCP) remains the single most cost-effective intervention in HIV+ patients at risk.

  • Discontinuation of Pneumocystis carinii Prophylaxis in Patients Infected with Human Immunodeficiency Virus: A Meta-Analysis and Decision Analysis. Trikalinos, Thomas A.; Ioannidis, John P.A. // Clinical Infectious Diseases;12/1/2001, Vol. 33 Issue 11, p1901 

    We performed a meta-analysis and a decision analysis on the discontinuation of prophylaxis for Pneumocystis carinii pneumonia (PCP) in patients infected with human immunodeficiency virus who had adequate immune recovery while receiving highly active antiretroviral therapy. In the meta-analysis...

  • Pneumocystis carinii pneumonia.  // MMWR: Morbidity & Mortality Weekly Report;6/27/1997 Supplement RR-12, Vol. 46, p4 

    Provides information on the disease pneumocystis carinii pneumonia. Recommendation made by authorities relating to the prevention of exposure to disease; Precautions that should be considered by adolescents, adults and pregnant women.

  • Is It Safe to Discontinue Primary Pneumocystis jiroveci Pneumonia Prophylaxis in Patients with Virologically Suppressed HIV Infection and a CD4 Cell Count <200 Cells/μL? Furrer, Hansjakob // Clinical Infectious Diseases;9/1/2010, Vol. 51 Issue 5, p611 

    Background. Current guidelines suggest that primary prophylaxis for Pneumocystis jiroveci pneumonia (PcP) can be safely stopped in human immunodeficiency virus (HIV)-infected patients who are receiving combined antiretroviral therapy (cART) and who have a CD4 cell count 1200 cells/μL. There...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics