Raymond A Smego, Shashi Nagar, Bonnie Maloba, Mirjana Popara.
Salvage Therapy for Pneumocystis Carinii Pneumonia: A Meta-Analysis.
Infect Dis J Jan ;10(1):4-8.

Objective: To determine the relative efficacies of alternative anti -pneumocystis agents in human immunodeficiency virusinfected patients with Pneumocystis carinii pneumonia unresponsive to primary drug treatment with trimethoprim sulfamethoxazole (TMP-SMX) or parenteral pentamidine. Methods: Meta-analysis of 27 published clinical drug trials, case series, and case reports involving P. carinii pneumonia. Data extracted included underlying disease; primary anti-pneumocystis treatment; days of failed primary treatment; salvage regimen, use of systemic corticosteroids and antiretroviral drugs; and clinical outcome. Four hundred and ninety-seven patients with microbiologicallyconfirmed P. carinii pneumonia (456 with HIV/AIDS) who failed initial antipneumocystis treatment and required alternative drug therapy. Results: Failed regimens included TMP-SMX (160 patients), iv pentamidine (63), TMPSMX and/or pentamidine (258), aerosolized pentamidine (6), atovaquone (3), dapsone (3), trimethoprim-dapsone (2), and TMPSMX followed by clindamycin-primaquine (2). Efficacies of salvage regimens were as follows: clindamycin-primaquine (42-46/48 patients; 88%-92%); p 10-8), atovaquone (4/5; 80%); eflomithine (40/70; 57%; p 0.01); TMP-SMX (27/51; 53%; p 0.08), pentamidine (64/164; 39%), and trimetrexate (47/159; 30%). Conclusion: The combination of clindamycin plus primaquine appears to be the most effective alternative treatment for patients with P. carinii pneumonia who are unresponsive to conventional antipneumocystis agents.

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