Adverse Reactions And Effects Of Aerosolized Pentamidine

Inadequate experience has been obtained to determine the incidence of the infrequent adverse reactions that will be associated with aerosolized pentamidine therapy for acute PCP. In case reports, bronchial bleeding has been reported with high-dose therapy in one center [43]. This was associated with an invasive procedure and has not been seen in the large prospective treatment trial. Case reports of hypoglycemia, rash, and conjunctivitis have also been reported [44,45]. The conjunctivitis is not unexpected; it would be the direct consequence of improper administration of the aerosol to the eyes, because it is well known that pentamidine is irritating to the airways [46].

The systemic side effects of aerosolized pentamidine when used as prophylaxis reported to date occur at a frequency of less than 1% and include mild hypoglycemia and pancreatitis [36]. Airway irritation with cough (10-20%) or bronchospasm (1-2%) occurs commonly [36]. The cough apparently responds to bronchodilators [36]. The long-term pulmonary effects of aerosolized pentamidine do not appear to cause permanent airflow obstruction or decreases in diffusing capacity [36]. Pneumothoraxes are not uncommon in all patients who have had PCP, but those receiving aerosolized pentamidine have an incidence of about 4% a year, not different than historical controls [47,48]. Aerosolized pentamidine does not appear to cause additive or synergistic toxicity to zidovudine but is synergistic in reducing the incidence of PCP [34]. Extrapulmonary infection with P. carinii is rare, even if aerosolized pentamidine prophylaxis is used. The total incidence in the San Francisco studies was less than 1 in 200. Most, but not all, cases have been reported in patients who have a history of PCP. Usual sites include the eye, ear canal, liver, and spleen. The presence of extrapulmonary pneumocystosis should be considered when evaluation of patients on aerosolized pentamidine reveals unexplained systemic signs and symptoms [36].

Complications due to pentamidine administration used in prophylaxis following bone marrow transplantation have been observed [49]. Indeed, aerosolized pentamidine was associated with increased risk of other infections and decreased survival rate.

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