CLINDAMYCIN PRIMAQUINE AS PROPHYLAXIS FOR PNEUMOCYSTIS-CARINII PNEUMONIA/

The records of 206 patients with advanced infection due to human immun odeficiency virus type 1 who were receiving prophylaxis with clindamyc in/primaquine (CIP), trimethoprim-sulfamethoxazole (TMP-SMZ), or dapso ne to prevent Pneumocystis carinii pneumonia (PCP) were retrospectivel y examined. Two hundred sixty-two patient-years of prophylaxis were ac crued (176.2 of TMP-SMZ, 63.4 of dapsone, and 22.8 of CIP). The rates of PCP in the TMP-SMZ, dapsone, and CIP groups were 3.9, 11.0, and 30. 7 per 100 patient-years, respectively. Pairwise comparisons showed CIP to be less effective than TMP-SMZ (relative risk [RR], 9.02; 95% conf idence interval [CI], 3.03-26.83). A similar trend was apparent for CI P vs. dapsone (RR, 2.78; 95% CI, 0.98-7.93). When only those receiving primary prophylaxis were analyzed, C/P recipients remained at greater risk than TMP-SMZ recipients (RR, 13.19; 95% CI, 3.54-49.12) and daps one recipients (RR, 3.85; 95% CI, 1.12-13.31). Failure of CIP prophyla xis could be due, at least in part, to underdosing (clindamycin, 300 m g/d; primaquine, 15 mg/d), CIP recipients had more nonspecific diarrhe a than did TMP-SMZ recipients (RR, 2.99; 95% CI, 1.61-5.55).