Atovaquone Compared with Dapsone for the Prevention of Pneumocystis carinii Pneumonia in Patients with HIV Infection Who Cannot Tolerate Trimethoprim, Sulfonamides, or Both

Authors

Wafaa M. El-Sadr , M.D., M.P.H., Columbia University College of Physicians and Surgeons
Robert L. Murphy , M.D., Northwestern University
Teresa McCabe Yurik , M.S., University of Minnesota
Roberta Luskin-Hawk , M.D., St. Joseph's Medical Center
Tony W. Cheung , M.D., Mount Sinai Medical Center
Henry H. Balfour , Jr., M.D., University of Minnesota
Robert Eng , M.D., East Orange Veterans Affairs Hospital
Thomas M. Hooton , M.D., University of Washington - Seattle Campus
Thomas M. Kerkering , M.D., Virginia Commonwealth University
Malte Schutz , M.D., Illinois Masonic Medical Center
Charles van der Horst , M.D., University of North Carolina at Chapel Hill
Richard Hafner , M.D., National Institutes of Allergy and Infectious Diseases

Document Type

Article

Original Publication Date

1998

Journal/Book/Conference Title

The New England Journal of Medicine

Volume

339

Issue

26

First Page

1889

Last Page

1895

DOI of Original Publication

10.1056/NEJM199812243392604

Comments

Originally published at http://dx.doi.org/10.1056/NEJM199812243392604

Date of Submission

January 2015

Abstract

BACKGROUND

Although trimethoprim–sulfamethoxazole is the drug of choice for the prevention of Pneumocystis carinii pneumonia, many patients cannot tolerate it and must switch to an alternative agent.

METHODS

We conducted a multicenter, open-label, randomized trial comparing daily atovaquone (1500-mg suspension) with daily dapsone (100 mg) for the prevention of P. carinii pneumonia among patients infected with the human immunodeficiency virus who could not tolerate trimethoprim–sulfamethoxazole. The median follow-up period was 27 months.

RESULTS

Of 1057 patients enrolled, 298 had a history of P. carinii pneumonia.P. cariniipneumonia developed in 122 of 536 patients assigned to atovaquone (15.7 cases per 100 person-years), as compared with 135 of 521 in the dapsone group (18.4 cases per 100 person-years; relative risk for atovaquone vs. dapsone, 0.85; 95 percent confidence interval, 0.67 to 1.09; P=0.20). The relative risk of death was 1.07 (95 percent confidence interval, 0.89 to 1.30; P=0.45), and the relative risk of discontinuation of the assigned medication because of adverse events was 0.94 (95 percent confidence interval, 0.74 to 1.19; P=0.59). Among the 546 patients who were receiving dapsone at base line, the relative risk of discontinuation because of adverse events was 3.78 for atovaquone as compared with dapsone (95 percent confidence interval, 2.37 to 6.01; P

CONCLUSIONS

Among patients who cannot tolerate trimethoprim–sulfamethoxazole, atovaquone and dapsone are similarly effective for the prevention ofP. carinii pneumonia. Our results support the continuation of dapsone prophylaxis among patients who are already receiving it. However, among those not receiving dapsone, atovaquone is better tolerated and may be the preferred choice for prophylaxis against P. cariniipneumonia.

Rights

From The New England Journal of Medicine, El-Sadr, W.M., Murphy, R.L., Yurik, T.M., et al., Atovaquone Compared with Dapsone for the Prevention of Pneumocystis carinii Pneumonia in Patients with HIV Infection Who Cannot Tolerate Trimethoprim, Sulfonamides, or Both, Vol. 339, Page 1889, Copyright © 1998 Massachusetts Medical Society. Reprinted with permission.

Is Part Of

VCU Internal Medicine Publications