RESUMEN
The increased risk of infection among older patients can be divided into three clinical categories: infections increased in incidence, infections showing higher case fatality rates, and infections that are clinically worse, primarily because of late recognition. Among infections that are increased in incidence, the most important by far are tuberculosis and pneumococcal pneumonia. Infections that show higher fatality rates include influenza and--again--pneumococcal pneumonia. Intra-abdominal infections (eg, cholecystitis and appendicitis) are often clinically worse in older patients due to late recognition and delay in surgical intervention.
Asunto(s)
Envejecimiento , Infecciones Bacterianas , Virosis , Anciano , Envejecimiento/inmunología , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/fisiopatología , Geriatría , Humanos , Factores de Riesgo , Virosis/epidemiología , Virosis/fisiopatologíaRESUMEN
OBJECTIVE: To compare the clinical efficacy and safety of trimethoprim-sulfamethoxazole (TMP-SMX) with pentamidine in the therapy of Pneumocystis carinii pneumonia (PCP) in patients with AIDS. PATIENTS, PARTICIPANTS: TMP-SMX (TMP, 20 mg/kg/day plus SMX, 100 mg/kg/day) was compared with pentamidine (4 mg/kg/day), both administered intravenously for 21 days in a prospective randomized treatment trial of 163 patients diagnosed with PCP between November 1984 and May 1988. RESULTS: Ninety-two evaluable patients received TMP-SMX as initial therapy; 68 received pentamidine. Failure to complete therapy was common. Of those receiving TMP-SMX, 39 (42%) required change in therapy because of failure to respond, and an additional 31 (34%) because of drug toxicity. This compared with 27 (40%; P = 0.733) and 17 (25%; P = 0.235), respectively, in the pentamidine-treated group. The overall survival rates were similar in the two groups, 62 out of 92 (67%) initially administered TMP-SMX versus 50 out of 68 (74%) initially administered pentamidine (P = 0.402). The survival rates for patients requiring a change in therapy because of failure to respond was 46% (18 out of 39) for the TMP-SMX group compared with 56% (15 out of 27) for the pentamidine group. When a change in therapy was made because of toxicity, survival rates were 97% (30 out of 31) for those receiving TMP-SMX versus 94% (16 out of 17) for those receiving pentamidine. CONCLUSION: TMP-SMX and pentamidine are of equivalent efficacy as initial therapies for PCP in patients with AIDS.