1. Pneumocystosis—Pentamidine is a well-established alternative therapy for pulmonary and extrapulmonary disease caused by P jiroveci. The drug has somewhat lower efficacy and greater toxicity than trimethoprim-sulfamethoxazole. The standard dosage is 3 mg/kg/d intravenously for 21 days. Significant adverse reactions are common, and with multiple regimens now available to treat P jiroveci infection, pentamidine is best reserved for patients with severe disease who cannot tolerate or fail other drugs.
Pentamidine is also an alternative agent for primary or secondary prophylaxis against pneumocystosis in immunocompromised individuals, including patients with advanced AIDS. For this indication, pentamidine is administered as an inhaled aerosol (300 mg inhaled monthly). The drug is well tolerated in this form. Its efficacy is good but less than that of daily trimethoprim-sulfamethoxazole.
TABLE 52–6 Treatment of African trypanosomiasis.
1Available in the USA from the Drug Service, CDC, Atlanta, Georgia (phone: 404-639-3670; www.cdc.gov/laboratory/drugservice/).
TABLE 52–7 Treatment of other protozoal infections. Not all preparations are available in the USA.1
Visceral (L donovani, L chagasi, L infantum) or mucosal (L braziliensis)
Cutaneous (L major, L tropica, L mexicana, L braziliensis)
Sodium stibogluconate, 20 mg/kg/d IV or IM for 28 days
Amphotericin (liposomal preparations preferred (3 mg/kg/d IV on days 1–5, 14, and 21)); various other dosing regimens, including single dose
Miltefosine, 2.5 mg/kg/d for 28 days
Paromomycin,15 mg/kg for 21 days Sodium stibogluconate, 20 mg/kg/d IV or IM for 20 days Meglumine antimoniate
Pentamidine, 2–4 mg/kg IM daily or every other day for up to 15 doses
Combinations of listed drugs
Pregnancy Spiramycin, 3 g daily until delivery
TABLE 52–7 Treatment of other protozoal infections. Not all preparations are available in the USA.1 (Continued)
Tinidazole, 2 g once 1Additional information may be obtained from the Parasitic Disease Drug Service, Parasitic Diseases Branch, CDC, Atlanta, Georgia (phone: 404-639-3670; www.cdc.gov/ laboratory/drugservice/).
2Established, relatively simple dosing regimens are provided. Route is oral unless otherwise indicated. See text for additional information, toxicities, cautions, and discussions of dosing for the more rarely used drugs, many of which are highly toxic.
3Specific recommendations for leishmaniasis vary geographically. Combination regimens are increasingly used.
4P jiroveci (carinii in animals) has traditionally been considered a protozoan because of its morphology and drug sensitivity, but molecular analyses have shown it to be most closely related to fungi.
2.