Corticosteroids as Adjunctive Therapy for Pneumocystis Pneumonia in Patients with AIDS

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Abstract
The National Institutes of Health (NIH)—University of California Expert Panel has concluded (Nov. 22 issue)1 that early adjunctive corticosteroid therapy benefits patients with moderate-to-severe Pneumocystis carinii pneumonia. The consensus panel has recommended the regimen used by the California Collaborative Treatment Group, which provides an initial daily dose of 80 mg of oral prednisone, tapered to 20 mg during a 21-day course.2 An alternative approach, not studied in any of the recent trials, was used by my colleagues and me in one of the early reports of successful adjunctive corticosteroid therapy for P. carinii pneumonia.3 Three patients had a dramatic reversal of hypoxemia and diffuse pulmonary infiltrates after treatment with high-dose intravenous methylprednisolone (1.0 to 1.8 g, given every 6 hours for 12 to 48 hours), without subsequent rebound deterioration. Our rationale was based on the clinical and pathological similarity between severe P. carinii pneumonia and the adult respiratory distress syndrome (ARDS). Although recent studies have failed to demonstrate a benefit of high-dose corticosteroids in the treatment of ARDS, a selective effect on pneumocystis-associated ARDS must be considered.4 , 5