Treatment time and patient tolerance for pentamidine delivery by Respirgard II and AeroTech II

BACKGROUND: The U.S. Public Health Service has recommended aerosolized pentamidine for prophylaxis for Pneumocystis carinii pneumonia in HIV-infected persons. We compared the Respirgard II and the AeroTech II nebulizer systems to determine whether nebulizer output differences would affect patient tolerance and treatment time. METHOD: Equivalent monthly doses were approximated based on results from previous nebulizer studies - 300 mg for the Respirgard II and 150 mg for the AeroTech II. Twenty-four patients received two monthly randomized treatments, one with each nebulizer. Treatments were administered in our outpatient clinic. Patient tolerance was evaluated by use of a cough scale. RESULTS: Treatment time for the Respirgard II ranged from 15 to 60 min, with a mean (SD) of 29.1 (9.6). For the AeroTech II, treatment time was significantly shorter (p < 0.0001) with a narrower range (10 to 15 min, with a mean [SD] of 13.0 [1.7]). Patients were more likely to cough during treatment with the AeroTech II (p = 0.014); however, this did not have an impact on patient tolerance. Twenty one of the twenty-four patients completed treatment with both nebulizers without major adverse reactions. CONCLUSION: We conclude that pentamidine aerosol from either nebulizer can be tolerated by patients for prophylaxis and that nebulizer selection may affect the cost and time of therapy.