Markedly reduced mortality associated with corticosteroid therapy of Pneumocystis carinii pneumonia in children with acquired immunodeficiency syndrome

• Published in: Archives of pediatrics & adolescent medicine Vol. 148; no. 6; p. 638
• Main Authors: Bye, M R, Cairns-Bazarian, A M, Ewig, J M
• Format: Journal Article
• Language: English
• Published: United States 01.06.1994
• Subjects: Acquired Immunodeficiency Syndrome - complications; Child; Child, Preschool; Humans; Injections, Intravenous; Methylprednisolone Hemisuccinate - administration & dosage; Methylprednisolone Hemisuccinate - therapeutic use; Pneumonia, Pneumocystis - drug therapy; Pneumonia, Pneumocystis - mortality; Prednisone - administration & dosage; Prednisone - therapeutic use; Survival Rate; Treatment Outcome
• ISSN: 1072-4710
• DOI: 10.1001/archpedi.1994.02170060092018

Pneumocystis carinii pneumonia is a common opportunistic infection in pediatric acquired immunodeficiency syndrome (AIDS). Mortality rates of 34% have been reported for the acute infection, with much higher mortality rates occurring in the presence of respiratory failure. Corticosteroids reduce the morbidity and mortality in adults with AIDS and P carinii pneumonia. We report herein our experience with corticosteroids in P carinii pneumonia in pediatric AIDS. When the data on adults were published, we began treating our patients with corticosteroids. We compared these children (group 1) with those children treated in a similar manner, but without corticosteroids (group 2). The two groups had similar ages, initial serum lactate dehydrogenase levels, and initial alveolar-arterial difference in partial pressure of oxygen. There was a significant (P < .001) reduction in the need for mechanical ventilation and in mortality in the corticosteroid-treated group. Corticosteroid therapy during acute infection with P carinii in young children with AIDS appears to significantly reduce morbidity (as measured by the need for mechanical ventilation) and mortality.