TY - JOUR
T1 - Use of dapsone in the prevention and treatment of Pneumocystis carinii pneumonia
T2 - A review
AU - Hughes, Walter T.
N1 - Funding Information:
Received 31 October 1997; revised 20 February 1998. Financial support: National Cancer Institute (P01 CA-20180 and P30 CA-21765), National Institutes of Allergy and Infectious Diseases (Pediatric ACTG, U01 AI32908), and the American Lebanese Syrian Associated Charities. Reprints or correspondence: Dr. Walter T. Hughes, 332 North Lauderdale, Memphis, Tennessee 38105.
PY - 1998
Y1 - 1998
N2 - Dapsone, with or without trimethoprim or pyrimethamine, has strong anti- Pneumocystis carinii activity, as demonstrated by in vitro methods, animal studies, and clinical trials. The drug blocks folic acid synthesis of P. carinii by inhibition of dihydropteroate synthetase activity. Dapsone is efficiently absorbed (70%-80%) from the gastrointestinal tract, reaches peak serum concentration in 2-6 hours, and is adequately distributed to the fluid of the alveolar spaces. Synergistic effects against P. carinii are noted when trimethoprim is combined with dapsone. This combination is recommended for therapeutic use for P. carinii pneumonia (PCP) as an alternative for patients who cannot take trimethoprim-sulfamethoxazole (TMP-SMZ). Evidence from more than 40 studies of dapsone as prophylaxis for PCP in AIDS patients shows that dapsone, either alone or in combination with pyrimethamine, is as effective as aerosolized pentamidine or atovaquone but slightly less effective than TMP-SMZ. Adverse effects include rash, anemia, methemoglobinemia, agranulocytosis, and hepatic dysfunction. Desensitization can be accomplished with many cases. Dapsone is the most cost-effective prophylaxis currently available for PCP.
AB - Dapsone, with or without trimethoprim or pyrimethamine, has strong anti- Pneumocystis carinii activity, as demonstrated by in vitro methods, animal studies, and clinical trials. The drug blocks folic acid synthesis of P. carinii by inhibition of dihydropteroate synthetase activity. Dapsone is efficiently absorbed (70%-80%) from the gastrointestinal tract, reaches peak serum concentration in 2-6 hours, and is adequately distributed to the fluid of the alveolar spaces. Synergistic effects against P. carinii are noted when trimethoprim is combined with dapsone. This combination is recommended for therapeutic use for P. carinii pneumonia (PCP) as an alternative for patients who cannot take trimethoprim-sulfamethoxazole (TMP-SMZ). Evidence from more than 40 studies of dapsone as prophylaxis for PCP in AIDS patients shows that dapsone, either alone or in combination with pyrimethamine, is as effective as aerosolized pentamidine or atovaquone but slightly less effective than TMP-SMZ. Adverse effects include rash, anemia, methemoglobinemia, agranulocytosis, and hepatic dysfunction. Desensitization can be accomplished with many cases. Dapsone is the most cost-effective prophylaxis currently available for PCP.
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U2 - 10.1086/514626
DO - 10.1086/514626
M3 - Review article
C2 - 9675476
AN - SCOPUS:0031857748
SN - 1058-4838
VL - 27
SP - 191
EP - 204
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 1
ER -