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Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
Dibrompropamidine is an antibacterial agent used for topical therapy. It is active against streptococci and staphylococci, including penicillin-resistant strains. It also has some activity against gram-negative microorganisms. In pharmaceutical products, dibrompropamidine is usually employed as dibrompropamidine isethionate (CAS number 614-87-9, EC number 210-399-5, molecular formula C21H30Br2N4O10S2) (1).
Pneumocystis Carinii Pneumonia *
Published in Lourdes R. Laraya-Cuasay, Walter T. Hughes, Interstitial Lung Diseases in Children, 2019
Pentamidine isethionate must be given parenterally. The dosage is 4.0 mg/kg/day. The total dosage should not exceed 56 mg/kg. I.m. injections should be given deeply into the anterolateral aspect of the thigh. If the drug is given intravenously it should be given over a period of at least 1 hr by infusion. The adverse effects associated with pentamidine administration are nephrotoxicity, hypoglycemia, hyperglycemia, hypotension, hypocalcemia, thrombocytopenia, anemia, impaired hepatic function, and necrosis at injection sites.
Pentamidine
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Intravenous pentamidine (4 mg/kg) has been successfully used for therapy of PJP in children (Siegel et al., 1984). Inhaled nebulized pentamidine has been used successfully to prevent PJP in children at risk (Principi et al., 1996). The Centers for Disease Control (CDC) recommends 300 mg given via Respirgard II nebulizer for children > 5 years (Mofenson et al., 2009). Aerosolized pentamidine appears to be effective in children < 5 years age (including an 8-month-old). The doses ranged from 60 mg every 2 weeks to 150 mg per month (Katz and Rosen, 1991; Principi et al., 1996). Intravenous pentamidine has been used effectively as second-line PJP prophylaxis in children who have undergone hematopoietic stem cell transplantation, including children less than 2 years of age (31 patients). The dose of pentamidine isethionate used was 4 mg/kg that was dosed every 2 weeks. Children < 40 kg were administered a more dilute infusion with a drug constituted at a concentration of 2 mg/ml compared with the standard concentration of 6 mg/ml. Delivery of the drug at the more dilute 2 mg/ml concentration was not associated with hypotension in contrast to the standard 6-mg/ml concentration. Data for pharmacokinetic studies in children are not available (Levy et al., 2016). Pentamidine dosed intravenously every 3 or 4 weeks also appears to be effective for PJP prophylaxis in children (Kim et al., 2008; Orgel and Rushing, 2014; Clark et al., 2015).
Systemic Miltefosine as an Adjunct Treatment of Progressive Acanthamoeba Keratitis
Published in Ocular Immunology and Inflammation, 2021
Andrea Naranjo, Jaime D. Martinez, Darlene Miller, Rahul Tonk, Guillermo Amescua
In vitro studies of MLT activity against Acanthamoeba have shown 100% eradication of the trophozoites and varying cysticidal activity; however, the required concentration of MLT to achieve this effect varies depending on the Acanthamoeba strain.17,18 Animal studies have demonstrated increased efficacy using topical MLT when compared to standard medical treatment as propamidine isethionate and polyhexanide19,20 and further determined that the best results were obtained when using a combination of polyhexamethylene biguanide plus MLT.20 Of note, animal models do not exhibit severe inflammation. However, a pilot study of topical MLT in vivo showed that topical MLT failed as monotherapy as all of the five patients included in the study had an increase in size and/or density of infiltrate after at least 1 week of treatment with MLT.1
The efficacy and safety of reduced-dose sulfamethoxazole-trimethoprim for chemoprophylaxis of Pneumocystis pneumonia in patients with rheumatic diseases
Published in Modern Rheumatology, 2021
Tomoya Harada, Ryohei Kato, Yuriko Sueda, Yoshihiro Funaki, Miki Takata, Ryota Okazaki, Yasuyuki Hasegawa, Akira Yamasaki
The first-line prophylactic agent against PCP is the oral administration of low-dose sulfamethoxazole-trimethoprim (SMX/TMP) [11,12]. The prevention rate in HIV-positive patients is 89–100% [13–15]. In patients with rheumatic disease, the SMX/TMP prophylactic method has high efficacy, and the prevention rate is 85–100% when the treatment is adequately adhered to and tolerated [11,16,17]. Despite the high efficacy of SMX/TMP, the administration of SMX/TMP to patients with rheumatic diseases often induces adverse events (AEs) such as rash, electrolyte abnormalities, renal dysfunction, and elevated liver enzymes. Clinicians often have to discontinue or reduce the dose of SMX/TMP because of AEs. Patients who discontinue SMX/TMP are administered alternate second-line prophylactic agents such as inhaled pentamidine isethionate and atovaquone [18]. Atovaquone is less effective than SMX/TMP in patients with acquired immunodeficiency syndrome [19], and it is more expensive than SMX/TMP. The prophylactic effect of inhaled pentamidine isethionate is inferior to that of SMX/TMP [20]. Therefore, increasing the retention rate of SMX/TMP for preventing PCP is important.
CD40 ligand deficiency: treatment strategies and novel therapeutic perspectives
Published in Expert Review of Clinical Immunology, 2019
Tabata T. França, Lucila A. Barreiros, Basel K. al-Ramadi, Hans D. Ochs, Otavio Cabral-Marques, Antonio Condino-Neto
Due to recurrent infections presented by patients with primary antibody deficiency, continuous and intermittent single-agent antibiotic therapies or rotational antibiotics are widely used to treat these patients [68]. Antibiotic prophylaxis in CD40L deficiency is recommended immediately after diagnosis. Briefly, antibiotic prophylaxis includes the administration of trimethoprim-sulfamethoxazole (TMP-SMX) per os (PO, orally), 5 mg/kg, 3 times per week [24,54]. Azithromycin (PO, 250 mg daily) has been suggested to reduce the incidence of cryptosporidium, but its efficacy in CD40L deficiency remains unclear [68] (Table 2). Alternative prophylactic regimens include pentamidine isethionate (5 mg/kg every 4 weeks), dapsone (1 mg/kg/d), and atovaquone (30 mg/kg/d) [54]. Although the selection of more virulent pathogens and increased antimicrobial resistance are common concerns related to the long-term use of antibiotics, there are no reports of adverse events with antibiotic prophylaxis in patients with CD40L deficiency [68].