Inhaled or Intravenous Pentamidine Therapy for Pneumocystis carinii Pneumonia in AIDS

Abstract

Objective: To compare inhaled pentamidine with intravenous pentamidine for the treatment of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome (AIDS).

Design: A randomized trial.

Setting: Community teaching hospital and hospital-based outpatient treatment center.

Patients: Twenty-one homosexual men with Pneumocystis pneumonia; 11 received inhaled pentamidine and 10 received intravenous pentamidine.

Intervention: Inhaled (8 mg/kg body weight) or intravenous (4 mg/kg body weight) pentamidine administered daily for 21 days.

Measurements and Main Results: All patients responded to intravenous pentamidine, whereas 6 of 11 (55%; 95% CI, 23% to 83%; P = 0.02, Fisher exact test) responded to inhaled pentamidine therapy. Two patients who failed inhaled pentamidine therapy eventually died despite appropriate intravenous therapy (mortality rate, 18%; CI, -6% to 42%). Nonresponders to inhaled pentamidine had a greater severity of illness compared with responders to this therapy, as shown by a lower mean (± SE) PaO₂ (8.0 ± 0.4 kPa compared with 10.8 ± 0.6 kPa; P = 0.005) and higher alveolararterial PO₂ difference (6.8 ± 0.6 kPa compared with 2.8 ± 0.8 kPa; P = 0.003).

Conclusions: Inhaled pentamidine is probably as effective as intravenous pentamidine in patients with mild Pneumocystis pneumonia. However, its use as sole therapy in patients with moderate to severe Pneumocystis pneumonia is not supported by the results of our study and is not warranted.