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Emil Toma, Anona Thorne, Joel Singer, Janet Raboud, Claude Lemieux, Sylvie Trottier, Michel G. Bergeron, Chris Tsoukas, Julian Falutz, Richard Lalonde, Christiane Gaudreau, Rachel Therrien, CTN-PCP Study Group, Clindamycin with Primaquine vs. Trimethoprim-Sulfamethoxazole Therapy for Mild and Moderately Severe Pneumocystis carinii Pneumonia in Patients with AIDS: A Multicenter, Double-Blind, Randomized Trial (CTN 004), Clinical Infectious Diseases, Volume 27, Issue 3, September 1998, Pages 524–530, https://doi.org/10.1086/514696
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Abstract
This double-blind, randomized, multicenter trial compared clindamycin/primaquine (Cm/Prq) with trimethoprim-sulfamethoxazole (TMP-SMZ) as therapy for AIDS-related Pneumocystis carinii pneumonia (PCP). Forty-five patients received clindamycin (450 mg four times daily [q.i.d.]) and primaquine (15 mg of base/d); 42 received TMP-SMZ (320 mg/1,600 mg q.i.d. if weight of ⩾60 kg or 240 mg/1,200 mg q.i.d. if weight of <60 kg) plus placebo primaquine. Overall, the efficacy of Cm/Prq was similar to that of TMP-SMZ (success rate, 76% vs. 79%, respectively); Cm/Prq was associated with fewer adverse events (P = .04), less steroid use (P = .18), and more rashes (P = .07). These differences were even greater for patients with PaO2 of >70 mm Hg (P = .02, P = .04, and P = .02, respectively). For patients with PaO2 of ⩽70 mm Hg (23 Cm/Prq recipients and 21 TMP-SMZ recipients), the efficacy of Cm/Prq was similar to that of TMP-SMZ (success rate, 74% vs. 76%, respectively); Cm/Prq was associated with similar adverse events (P = .57), steroid use (P = .74), and rashes (P = .78). This trial confirms that Cm/Prq is a reasonable alternative therapy for mild and moderately severe PCP.