Miscellaneous Antibiotic Aerosols Pentamidine Aerosol

Patients with acquired immunodeficiency syndrome (AIDS) are susceptible to infections caused by the protozoan Pneumocystis carinii, which causes pneumonia (PCP). There is now good evidence that aerosol pentamidine is useful in treating mild PCP [195] and, even more important, that, used intermittently, it is effective as prophylaxis against PCP [196,197]. Pentamidine aerosol is delivered to the alveolar space, where the P. carinii organisms are found.

The deposition fraction of pentamidine is relatively low, around 2-3% of total dose in the nebulizer (Respirgard II); but as a fraction of total lung capacity, it is greater in children, leading to the suggestion that dose could be reduced in children [198]. Other studies indicate that deposition varies significantly, depending on nebulizer chosen, with deposition fraction measuring from 5.3% to 26.4% for the same subjects using different nebulizers [199] and, in other studies, from 2.9% to 14.3% among 12 different nebulizers, both ultrasonic and jet types [200].

Patients who relapse with PCP or who develop their first PCP episode while using pentamidine prophylaxis have pneumonia localized more to the upper lung zones. In patients not using pentamidine aerosol prophylaxis, the disease is diffuse, with perhaps some lower lung zone predominance. There is evidence that disease in the upper zones reflects failure of the pentamidine prophylaxis aerosol because of preferential deposition in as it enters the lower zones [201]. Inhalation of pentamidine in the supine position seems to cause redistribution of the aerosol to the upper zones [202]. In any case, the use of pentamidine aerosol for this purpose has declined greatly in since the early 1990s because of the low cost and proven success of oral trimethoprim/sulfa-methoxazole.

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