Without treatment, Pneumocystis carinii pneumonitis is almost always fatal in the immunocompromised host. Here, Walter Hughes discusses proven and potential treatments, and methods of chemoprophylaxis in high-risk patients. Two drugs, pentamidine isethionate and trimethoprimsulfamethoxazole, are equally effective therapeutically - permitting the recovery of approximately 75% of patients - but the latter drug combination is preferred because of its lower toxicity and fewer adverse effects. The pneumonitis can be prevented by prophylactic administration of trimethoprim-sulfamethoxazole. Other drugs with proven efficacy or under study include Fansidar, dapsone, trimetrexate and difluoromethylornithine.
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