המידע באדיבות medicontext.co.il
Last Updated: 2001-08-10 16:39:34 EDT (Reuters Health)
WESTPORT, CT (Reuters Health) – The World Health Organization (WHO) algorithm for managing respiratory tract infection in HIV-1-infected adults fails in nearly one third of patients with pneumonia, according to the results of a study conducted in Nairobi, Kenya.
"Respiratory tract infection is the most common cause of morbidity and mortality in HIV-1-infected individuals living in sub-Saharan Africa," Dr. Christina W. Mwachari, of the Kenya Medical Research Institute, in Nairobi, and colleagues explain in the August 1st issue of the Journal of Acquired Immune Deficiency Syndromes. Their new findings suggest that research is urgently needed to identify alternative treatment strategies for these patients.
The investigators examined the success of the WHO algorithm in 380 HIV-1-infected adults followed at Nairobi outpatient clinic from July 1997 through January 1999. A total of 597 episodes of respiratory tract infection were diagnosed in the cohort, including 177 cases of pneumonia and 420 cases of bronchitis. Pneumonia was more common among patients who were widowed, had less than 8 years of education, or CD4 cell counts below 200 cells/µL.
According to the WHO algorithm, first-line therapy for these patients consisted of ampicillin or antituberculosis therapy, when needed, and second-line treatment consisted of trimethoprim/sulfamethoxazole.
The WHO algorithm was significantly more successful in patients with bronchitis than in those with pneumonia (p<0.0001). Specifically, 32% of episodes of pneumonia required treatment with agents not listed in the algorithm, compared with only 3% of episodes of bronchitis. Many pneumonia patients responded to oral erythromycin or azithromycin after failing first- and second-line treatments.
Unfortunately, no clinical characteristics predicted which pneumonia patients would respond to the WHO-recommended therapies and which would not.
"Without more supportive evidence, oral ampicillin and trimethoprim-sulfamethoxazole cannot be recommended for treatment of pneumonia in our population of HIV-1-infected adults," Dr. Mwachari and her team conclude. Instead, they propose that "those with clinical signs and symptoms suggestive of pneumonia might benefit from treatment with a macrolide antibiotic and should be hospitalized if symptoms worsen or persist." The team also recommends further research to identify the optimal treatment strategy for this population.
J Acquir Immun Defic Syndr 2001;27:365-371.
-Westport Newsroom 203 319 2700
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