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chapter 44 Pentamidine 275
as appropriate) are necessary. Also, dosage
adjustment in patients with renal insufficiency
is recommended.
• Once-monthly inhaled pentamidine has reasonable
efficacy as a second-line agent for
prophylaxis against Pneumocystis pneumonia.
However, unlike TMP/SMX prophylaxis, cases
of extrapulmonary Pneumocystis infection have
been reported in patients on inhaled pentamidine.
Inhaled pentamidine also does not protect
against Toxoplasma disease or bacterial pneumonia
as TMP/SMX does.
What It’s Good For
IV pentamidine is an alternative drug for treatment
of severe Pneumocystis pneumonia; inhaled
pentamidine is an alternative for prophylaxis
against Pneumocystis pneumonia. IV pentamidine
is an alternative drug for treatment for leishmaniasis
and trypanosomiasis.
Don’t Forget!
Watch out for overlapping toxicities with pentamidine
and other drugs the patient may be on.
Patients receiving pentamidine are often severely
ill and may be on drugs like insulin, furosemide,
aminoglycosides, and antiarrhythmics that may
exacerbate pentamidine’s myriad adverse effects.