Document Detail


The possible role of corticosteroid therapy for pneumocystis pneumonia in the acquired immune deficiency syndrome (AIDS).
MedLine Citation:
PMID:  3265156     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Twenty-one episodes of Pneumocystis carinii pneumonia (PCP) and the acquired immune deficiency syndrome (AIDS) were treated with corticosteroids in the form of intravenous methylprednisolone or oral prednisone. A standard dose of 80 mg/day x 5 days was given for 15 episodes, whereas 6 patients received variable doses of 20-120 mg/day x 4-20 days. All were treated with trimethoprim-sulfamethoxazole (TMP-SMX). Comparison was made with 12 AIDS patients with PCP who were not treated with steroids. The steroid group was more severely ill than the controls as measured by alveolar-arterial oxygen difference but were otherwise comparable. Mortality from the pneumonia in the steroid group was 2/21 (10%) vs. 3/12 (25%) in the control group. Significant differences were seen in the following parameters: time to defervescence (1 day vs. greater than 9.3 days), the proportion of patients with pO2 greater than 70 mm Hg at day 5 [12/21 (57%) vs. 1/12 (9%)] and at day 10 [19/21 (90%) vs. 7/12 (58%)], and number of adverse drug reactions [4/21 (19%) vs. 9/12 (75%)]. There were fewer late relapses [1/19 (5%) vs. 2/9 (22%)] after a 5.5 month (mean) follow-up. All patients had improvements in their clinical status when initially given corticosteroid therapy but early relapses occurred when steroids were discontinued in five patients (24%). No other complications could be attributed to steroid therapy in this study. A brief course of high-dose corticosteroids appears to be beneficial in severely ill AIDS patients with pneumocystis pneumonia. This suggests the need for randomized, double-blind, placebo-controlled trials to confirm these findings.
Authors:
S Walmsley; I E Salit; J Brunton
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Publication Detail:
Type:  Clinical Trial; Controlled Clinical Trial; Journal Article    
Journal Detail:
Title:  Journal of acquired immune deficiency syndromes     Volume:  1     ISSN:  0894-9255     ISO Abbreviation:  J. Acquir. Immune Defic. Syndr.     Publication Date:  1988  
Date Detail:
Created Date:  1989-02-24     Completed Date:  1989-02-24     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8812597     Medline TA:  J Acquir Immune Defic Syndr     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  354-60     Citation Subset:  IM; X    
Affiliation:
Department of Medicine, Toronto General Hospital, Ontario, Canada.
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MeSH Terms
Descriptor/Qualifier:
Acquired Immunodeficiency Syndrome / complications*
Adult
Drug Administration Schedule
Humans
Male
Methylprednisolone / administration & dosage,  therapeutic use*
Middle Aged
Pilot Projects
Pneumonia, Pneumocystis / drug therapy*
Prednisone / administration & dosage,  therapeutic use*
Pulmonary Gas Exchange
Sulfamethoxazole / administration & dosage,  therapeutic use*
Trimethoprim / administration & dosage,  therapeutic use*
Chemical
Reg. No./Substance:
53-03-2/Prednisone; 723-46-6/Sulfamethoxazole; 738-70-5/Trimethoprim; 83-43-2/Methylprednisolone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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