Corticosteroids improve survival of children with AIDS and Pneumocystis carinii pneumonia
J. W. Sleasman, C. Hemenway, A. S. Klein and D. J. Barrett
Department of Pediatrics, University of Florida College of Medicine, Gainesville.
OBJECTIVE--To determine if corticosteroids administered in addition to
antimicrobials improve survival in children with acquired immunodeficiency
syndrome and severe Pneumocystis carinii pneumonia (PCP).
DESIGN--Before-after, nonrandomized, case-comparison study.
SETTING--Pediatric intensive care unit of a tertiary care teaching hospital
in Florida. PARTICIPANTS--Eleven children infected with the human
immunodeficiency virus (HIV) with confirmed PCP. SELECTION
PROCEDURE--Infants with HIV infection and acute respiratory failure due to
PCP were studied sequentially. INTERVENTION--The first seven infants were
treated with antimicrobials alone while the next four received a 2-week
course of methylprednisolone sodium succinate in addition to
antimicrobials. MEASUREMENTS AND RESULTS--The two groups were similar with
respect to age, route of HIV infection, stage of HIV disease, CD4 T-cell
count, antiretroviral therapy, and respiratory parameters at intubation.
All children treated with antimicrobials alone died while receiving
mechanical ventilation. Survival of the children who received
corticosteroid therapy was significantly improved (P < .05), and all
were weaned from the ventilator. CONCLUSIONS--Corticosteroids administered
in addition to antimicrobials and supportive care improve the short-term
survival of HIV-infected children who have acute respiratory failure due to
PCP.
