Diana Lewis Coleman

Trimethoprim-Sulfamethoxazole or Pentamidine for Pneumocystis carinii Pneumonia in the Acquired Immunodeficiency Syndrome: A Prospective Randomized Trial

Forty patients with the acquired immunodeficiency syndrome (AIDS) and their first episodes of Pneumocystis carinii pneumonia were assigned at random to receive either trimethoprim-sulfamethoxazole or pentamidine isethionate. The two groups did not differ significantly in the severity of pulmonary or systemic processes at enrollment. Five patients treated initially with trimethoprim-sulfamethoxazole and one patient treated initially with pentamidine died during the 21-day treatment period (p = 0.09, Fishers exact test). No significant differences were seen between groups in rates of improvement, pulmonary function tests, or 67Ga uptake by the lungs in the survivors at completion of therapy. Adverse reactions necessitated changing from the initial drug in 10 patients in the trimethoprim-sulfamethoxazole group and 11 in the pentamidine group. Minor reactions occurred in all patients. In patients with AIDS, trimethoprim-sulfamethoxazole and pentamidine do not have statistically significant differences in efficacy or frequency of adverse reactions.

An Outbreak of Pneumocystis carinii Pneumonia in Homosexual Men

Pneumocystis carinii pneumonia has rarely been reported in previously healthy persons over the age of 6 months. Five cases of P. carinii pneumonia in adult homosexual men, confirmed by biopsy results, are reported. All five patients were seropositive when tested for antibodies to cytomegalovirus and four had evidence of active concurrent cytomegalovirus infections. Kaposis sarcoma was shown in two of the patients and one had possible Pneumocystis infection of the central nervous system as well as P. carinii pneumonia. Three patients had second episodes of Pneumocystis pneumonia. Four of the five patients have died. Past or concurrent cytomegalovirus infection and homosexuality were the only common epidemiologic features in all five patients.

Airway Management of the Nonintubated Patient

Maintenance of an unobstructed airway and administra tion of controlled ventilation by face mask can save the life of the patient unable to sustain adequate spontane ous ventilation. Techniques for obtaining an unob structed airway are reviewed, as are methods of posi tioning and holding the face mask. Breathing bag systems used to deliver supplemental oxygen and posi tive-pressure ventilation to the nonintubated patient are discussed.