Aerosolized pentamidine and Pneumocystis carinii pneumonia: patient compliance and outcomes
D C Bjornson1, C N Oster, L M Cortese
1Walter Reed Army Medical Center (WRAMC), Washington, DC.
Objective:
The study objectives were to compare compliance between every-two-week and every-four-week aerosolized pentamidine regimens, and to determine if patients who were more compliant with the use of aerosolized pentamidine were at decreased risk for developing Pneumocystis carinii pneumonia (PCP).
Design:
Nonrandomized observational study of patients receiving aerosolized pentamidine for PCP prophylaxis using the hospital pharmacy computer system to document aerosolized pentamidine use and compliance, and the Patient Administration Division's computer to document cases of PCP.
Setting:
Tertiary care, US Army medical center.
Patients:
All patients who were prescribed aerosolized pentamidine (60 mg every two weeks, 300 mg every four weeks, or both) over a 3.5-year period.
Main Outcome Measures:
Mean percent compliance was determined and compared between every-two-week and every-four-week regimens. The relationship between compliance and cases of PCP as determined using nonparametric statistics.
Results:
Patients (n = 146) who were prescribed aerosolized pentamidine 60 mg every two weeks were more compliant (p = 0.006) than those prescribed 300 mg every four weeks. In addition, those patients who initially received the 60-mg regimen and were switched to the 300-mg regimen were more compliant when taking the 60-mg dose (p = 0.027). There was no association between compliance with either regimen and cases of PCP. Compliance generally was poor with both regimens.
Conclusions:
Patients on every-two-week regimens of aerosolized pentamidine were more compliant than those on every-four-week regimens. However, regardless of compliance, some patients failed aerosolized pentamidine over the 3.5-year period. Other agents that lend themselves to compliance may be more appropriate for PCP prophylaxis than aerosolized pentamidine.
Insights
Patients were more compliant with every-two-week aerosolized pentamidine than every-four-week regimens, but compliance was poor overall. No link was found between compliance and Pneumocystis carinii pneumonia (PCP) risk.
Area of Science:
- Infectious Disease
- Pulmonology
- Pharmacology
Background:
- Pneumocystis carinii pneumonia (PCP) prophylaxis is crucial for immunocompromised patients.
- Aerosolized pentamidine is a common prophylactic agent, but its effectiveness is influenced by patient compliance.
- Understanding compliance patterns is essential for optimizing PCP prevention strategies.
Purpose of the Study:
- To compare patient compliance between two-week and four-week aerosolized pentamidine regimens.
- To investigate the association between compliance with aerosolized pentamidine and the risk of developing PCP.
- To evaluate the overall effectiveness of aerosolized pentamidine for PCP prophylaxis.
Main Methods:
- A nonrandomized observational study was conducted at a US Army tertiary care medical center.
- Patient compliance was tracked using the hospital pharmacy computer system over a 3.5-year period.
- Data on PCP cases were obtained from the Patient Administration Division's computer system.
Main Results:
- Patients on the every-two-week regimen (60 mg) showed significantly higher compliance than those on the every-four-week regimen (300 mg).
- Compliance remained poor for both regimens, and no association was found between compliance levels and the incidence of PCP.
- Patients initially on the 60-mg regimen and switched to the 300-mg regimen were more compliant with the 60-mg dose.
Conclusions:
- Every-two-week aerosolized pentamidine regimens are associated with better patient compliance compared to every-four-week regimens.
- Despite compliance differences, aerosolized pentamidine showed treatment failures, suggesting limitations in its prophylactic efficacy.
- Alternative agents with potentially better compliance profiles may be more suitable for PCP prophylaxis.
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