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Previous Volume 339:1889-1895 December 24, 1998 Number 26 Next

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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. carinii pneumonia 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<0.001); among those not receiving dapsone at base line, it was 0.42 (95 percent confidence interval, 0.30 to 0.58; P<0.001).

Conclusions Among patients who cannot tolerate trimethoprim–sulfamethoxazole, atovaquone and dapsone are similarly effective for the prevention of P. 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. carinii pneumonia.

Source Information

From the Harlem Hospital Center and Columbia University College of Physicians and Surgeons, New York (W.M.E.); Northwestern University, Chicago (R.L.M.); the Division of Biostatistics, School of Public Health (T.M.Y.), and the School of Medicine (H.H.B.), University of Minnesota, Minneapolis; Saint Joseph's Medical Center, Chicago (R.L.-H.); Mount Sinai Medical Center, New York (T.W.C.); East Orange Veterans Affairs Hospital, East Orange, N.J. (R.E.); the University of Washington, Seattle (T.M.H.); the Medical College of Virginia, Virginia Commonwealth University, Richmond (T.M.K.); Illinois Masonic Medical Center, Chicago (M.S.); the University of North Carolina, Chapel Hill (C.H.); and the Division of AIDS, National Institutes of Allergy and Infectious Diseases, Bethesda, Md. (R.H.).

Address reprint requests to Dr. El-Sadr at the Division of Infectious Diseases, Rm. 3107, Harlem Hospital Center, 506 Lenox Ave., New York, NY 10037.

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Atovaquone Compared with Dapsone to Prevent Pneumocystis carinii Pneumonia
Horowitz H. W., Wormser G. P., El-Sadr W.
Extract | Full Text  
N Engl J Med 1999; 340:1512-1513, May 13, 1999. Correspondence

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