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Atovaquone for Pneumocystis carinii Pneumonia
- Case Western Reserve University, Cleveland, OH 44106-4984. University of North Carolina, Chapel Hill, NC 27519. Cornell University Medical College, New York, NY 10021. University of Cincinnati, Cincinnati, OH 45267-0564. Park Plaza Medical Center, Houston, TX 77004. Bristol Park Medical Group, Santa Ana, CA 92704.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
TO THE EDITOR:
The conclusion of the study by Dohn and colleagues [1] that “oral atovaquone and intravenous pentamidine have similar rates for successful treatment of mild and moderate P. carinii pneumonia” is misleading. More treatment failures were noted (29% compared with 17%) and more deaths (13% compared with 8%) occurred in patients treated with atovaquone than in those treated with pentamidine. Although the observed differences in this small study did not reach statistical significance, they are consistent with those obtained in a larger study showing the inferiority of atovaquone compared with trimethoprim-sulfamethoxazole, which is probably therapeutically equivalent to pentamidine [2, 3]. Because the authors discontinued enrollment prematurely, it is inappropriate for them to conclude that they have proved the null hypothesis, that is, that the two treatments do not differ. Atovaquone may be well tolerated, but the available data suggest that it is less effective than either pentamidine or trimethoprim-sulfamethoxazole. Reasonable alternatives for treatment of P. carinii pneumonia in patients with a history of intolerance to trimethoprim-sulfamethoxazole include, in addition to pentamidine, trimethoprim-dapsone, clindamycin-primaquine, and rechallenge or desensitization (or both) with trimethoprim-sulfamethoxazole [4, 5].
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
