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Evidence summaries

Prophylactic Treatments Against Pneumocystis Carinii Pneumonia and Toxoplasma Encephalitis in HIV-Infected Patients

Trimethoprim-sulfamethozazole prophylaxis may be more effective than dapsone/pyrimethamine or aerosolised pentamidine in the prophylaxis of Pneumocystis carinii pneumonia and toxoplasma encephalitis in HIV-infected patients. Level of evidence: "C"

A systematic review 1 including 22 RCTs with a total of 4 870 subjects was abstracted in DARE. For dapsone/pyrimethamine vs. aerosolised pentamidine the risk ratio for P. carinii pneumonia was 0.90 (95% CI 0.71 to 1.15) and for toxoplasma encephalitis it was 0.72 (95% CI 0.54 to 0.97). For trimethoprim-sulfamethoxazole vs. aerosolised pentamidine the risk ratio for P. carinii pneumonia was 0.59 (95% CI 0.45 to 0.76), and for toxoplasma encephalitis it was 0.78 (95% CI 0.55 to 1.11). For mortality it was 0.88 (95% CI 0.74 to 1.06). For trimethoprim-sulfamethoxazole vs. dapsone/pyrimethamine the risk ratio for P. carinii pneumonia was 0.49 (95% CI 0.26 to 0.92), and for toxoplasma encephalitis it was 1.17 (95% CI 0.68 to 2.04), and for mortality it was 0.98 (95% CI 0.80 to 1.08).

Comment: The quality of evidence is downgraded by study quality (few data of the original studies) and by imprecise results (limited study size for each comparison).

References

  • Bucher HC, Griffith L, Guyatt GH, Opravil M. Meta-analysis of prophylactic treatments against Pneumocystis carinii pneumonia and toxoplasma encephalitis in HIV-infected patients. J Acquir Immune Defic Syndr Hum Retrovirol 1997 Jun 1;15(2):104-14. [PubMed] [DARE]

Primary/Secondary Keywords