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Pentamedine IV treatments monthly?
Dec 17, 1996

I have been receiving IV Pentamedine treatments monthly for almost 2 years, because I cannot tolerate the other oral treatments,ie: the Sulfer drug? I havn't had a bout with PCP in over 2 years. My question is should I continue monthly IV treatments of pentamedine, my doctor seems to think so or should I try every other month or is there a pill on the horizon that I could take and end these horrible monthly treatments????? Thanks!!!!

Response from Dr. Cohen

Using IV pentamidine (or intramuscular injections of pentamidine) monthly or twice monthly has been studied as a method of PCP prophylaxis, and can be effective. It is not standard practice, though, primarily because the alternatives are easier and safer.

The drug of choice is trimethoprim-sulfamethoxazole (Bactrim, Septra). I recently answered a question on PCP in which I discussed the fact that many people who have had problems with sulfa drugs in the past are able to tolerate this drug a second time around, either through "desensitization" or through simply restarting the drug at the standard prophylaxis dose (one single-strength or double-strength tablet daily, or one double-strength tablet three times weekly).

If that's not an option, the second-line drug is dapsone. Some people are allergic to dapsone, and it makes others anemic. But for many, it's a safe and effective form of prophylaxis (at a dose of 100 mg daily).

The third choice is pentamidine, but it is given as a monthly aerosol treatment, not intravenously. It's easier that way, and since very little gets absorbed, it's much less toxic.

Those are the PCP prophylaxis recommendations from the US Public Health Service and the Infectious Diseases Society of America. If for some reason you can't take any of those three treatments, or if you've developed PCP while taking aerosolized pentamidine, some doctors add or change to atovaquone (Mepron). It's approved for the treatment of PCP, and is being studied to see if it's effective at preventing PCP. The dose is 750 mg twice daily, and it's fairly well-tolerated. Using azithromycin (Zithromax) or clarithromycin (Biaxin) to prevent MAC may also help to prevent PCP, but you wouldn't want to rely on those drugs alone.

For more information, see my article on "Prevention of Opportunistic Infections."

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