Failure of Pentamidine as Prophylaxis for Pneumocystis carinii Pneumonia in HIV-Infected Children

Abstract

Use of a combination of oral trimethoprim and sulfamethoxazole (TMP-SMZ) and aerosolized pentamidine are the only medications currently approved by the Centers for Disease Control and Prevention (CDC) for the prevention of Pneumocystis carinii pneumonia (PCP) in human immunodeficiency virus (HIV)–infected children. 1 However, adverse reactions to TMP-SMZ and the difficulty of administering aerosolized pentamidine in the pediatric population often necessitate the use of alternative prophylactic regimens, such as intramuscularly (IM) or intravenously (IV) administered pentamidine or orally administered dapsone. 2,3 At our institution, HIV-positive children who require prophylaxis for PCP and are intolerant of oral TMP-SMZ have received monthly IM or IV pentamidine therapy for prophylaxis for PCP. Pneumocystis carinii pneumonia developed in three of these children who had very low CD4+ cell counts for their age in spite of this regimen. Alternative regimens are necessary to prevent PCP in these severely immunodeficient children. Further clinical studies are needed