Skip to main content
PMC home page
Thorax logoLink to Thorax
. 1989 Jul;44(7):565–569. doi: 10.1136/thx.44.7.565

Nebulised pentamidine as treatment for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome.

R F Miller 1, P Godfrey-Faussett 1, S J Semple 1
PMCID: PMC461953  PMID: 2788936

Abstract

Nebulised pentamidine was used to treat 30 patients with Pneumocystis carinii pneumonia. Fourteen patients (group 1) received pentamidine isethionate 4 mg/kg (six patients) or 8 mg/kg (eight patients) via a standard jet nebuliser (Acorn, system 22) with a flow rate of 8 l/min. The aerosol droplets had a mass median aerodynamic diameter of 2.6 microns (geometric standard deviation (GSD) 2.9) and 46% of droplets were less than 3.9 microns. A further 16 patients (group 2) received 8 mg/kg pentamidine via a jet nebuliser with baffles to limit droplet size to below 4 microns (Respirgard II). This generated aerosol droplets with a mass median aerodynamic diameter of 0.8 micron (GSD 1.5) and 98% were less than 3.9 microns. Only three of the 14 patients in group 1 responded clinically to treatment, one after the lower dose of pentamidine. Treatment was discontinued in 10 patients and one patient died at bronchoscopy from haemorrhage. Thirteen of the 16 patients in group 2 responded. Side effects occurred infrequently; two patients from group 1 had a cough, six patients (four from group 2) had contact bleeding at bronchoscopy, and two further patients had haemoptysis. The differing response rate may be due to differences in the mean droplet size of the aerosols produced by the nebulisers. Nebulised pentamidine (8 mg/kg) when delivered by Respirgard II nebuliser appears to be as effective as conventional treatment for Pneumocystis carinii pneumonia of mild to moderate severity.

Full text

PDF
569

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Clay M. M., Pavia D., Newman S. P., Clarke S. W. Factors influencing the size distribution of aerosols from jet nebulisers. Thorax. 1983 Oct;38(10):755–759. doi: 10.1136/thx.38.10.755. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Debs R. J., Blumenfeld W., Brunette E. N., Straubinger R. M., Montgomery A. B., Lin E., Agabian N., Papahadjopoulos D. Successful treatment with aerosolized pentamidine of Pneumocystis carinii pneumonia in rats. Antimicrob Agents Chemother. 1987 Jan;31(1):37–41. doi: 10.1128/aac.31.1.37. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Karboski J. A., Godley P. J. Inhaled pentamidine and hypoglycemia. Ann Intern Med. 1988 Mar;108(3):490–490. doi: 10.7326/0003-4819-108-3-490_1. [DOI] [PubMed] [Google Scholar]
  4. Montgomery A. B., Debs R. J., Luce J. M., Corkery K. J., Turner J., Brunette E. N., Lin E. T., Hopewell P. C. Aerosolised pentamidine as sole therapy for Pneumocystis carinii pneumonia in patients with acquired immunodeficiency syndrome. Lancet. 1987 Aug 29;2(8557):480–483. doi: 10.1016/s0140-6736(87)91794-6. [DOI] [PubMed] [Google Scholar]
  5. Montgomery A. B., Debs R. J., Luce J. M., Corkery K. J., Turner J., Brunette E. N., Lin E. T., Hopewell P. C. Selective delivery of pentamidine to the lung by aerosol. Am Rev Respir Dis. 1988 Feb;137(2):477–478. doi: 10.1164/ajrccm/137.2.477. [DOI] [PubMed] [Google Scholar]
  6. Murray J. F., Felton C. P., Garay S. M., Gottlieb M. S., Hopewell P. C., Stover D. E., Teirstein A. S. Pulmonary complications of the acquired immunodeficiency syndrome. Report of a National Heart, Lung, and Blood Institute workshop. N Engl J Med. 1984 Jun 21;310(25):1682–1688. doi: 10.1056/NEJM198406213102529. [DOI] [PubMed] [Google Scholar]
  7. Rees P. J., Clark T. J., Morén F. The importance of particle size in response to inhaled bronchodilators. Eur J Respir Dis Suppl. 1982;119:73–78. [PubMed] [Google Scholar]
  8. Sattler F. R., Cowan R., Nielsen D. M., Ruskin J. Trimethoprim-sulfamethoxazole compared with pentamidine for treatment of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. A prospective, noncrossover study. Ann Intern Med. 1988 Aug 15;109(4):280–287. doi: 10.7326/0003-4819-109-4-280. [DOI] [PubMed] [Google Scholar]
  9. Smith D. E., Herd D., Gazzard B. G. Reversible bronchoconstriction with nebulised pentamidine. Lancet. 1988 Oct 15;2(8616):905–905. doi: 10.1016/s0140-6736(88)92500-7. [DOI] [PubMed] [Google Scholar]
  10. Wharton J. M., Coleman D. L., Wofsy C. B., Luce J. M., Blumenfeld W., Hadley W. K., Ingram-Drake L., Volberding P. A., Hopewell P. C. Trimethoprim-sulfamethoxazole or pentamidine for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. A prospective randomized trial. Ann Intern Med. 1986 Jul;105(1):37–44. doi: 10.7326/0003-4819-105-1-37. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES