Treatment Time and Patient Tolerance for Pentamidine Delivery by Respirgard II and AeroTech II

Abstract

Background

The U.S. Public Health Service has recommended aerosolized pentamidine for prophylaxis for Pneumocystis carinii pneumonia in HIV-infected persons. We compared the Respirgard II and the AeroTech II nebulizer systems to determine whether nebulizer output differences would affect patient tolerance and treatment time.

Method

Equivalent monthly doses were approximated based on results from previous nebulizer studies—300 mg for the Respirgard II and 150 mg for the AeroTech II. Twenty-four patients received two monthly randomized treatments, one with each nebulizer. Treatments were administered in our outpatient clinic. Patient tolerance was evaluated by use of a cough scale.

Results

Treatment time for the Respirgard II ranged from 15 to 60 min, with a mean (SD) of 29.1 (9.6). For the AeroTech II, treatment time was significantly shorter (p < 0.0001) with a narrower range (10 to 15 min, with a mean [SD] of 13.0 [1.7]). Patients were more likely to cough during treatment with the AeroTech II (p = 0.014); however, this did not have an impact on patient tolerance. Twenty one of the twenty-four patients completed treatment with both nebulizers without major adverse reactions.

Conclusion

We conclude that pentamidine aerosol from either nebulizer can be tolerated by patients for prophylaxis and that nebulizer selection may affect the cost and time of therapy.