June 1994

Markedly Reduced Mortality Associated With Corticosteroid Therapy of Pneumocystis carinii Pneumonia in Children With Acquired Immunodeficiency Syndrome

Author Affiliations

From the Division of Pediatric Pulmonary Medicine, Department of Pediatrics, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY. Dr Bye is now with Columbia Presbyterian Medical Center, New York, NY.

Arch Pediatr Adolesc Med. 1994;148(6):638-641. doi:10.1001/archpedi.1994.02170060092018

Background:  Pneumocystis carinii pneumonia is a common opportunistic infection in pediatric acquired immunodeficiency syndrome (AIDS). Mortality rates of 34% have been reported for the acute infection, with much higher mortality rates occurring in the presence of respiratory failure. Corticosteroids reduce the morbidity and mortality in adults with AIDS and P carinii pneumonia. We report herein our experience with corticosteroids in P carinii pneumonia in pediatric AIDS.

Methods:  When the data on adults were published, we began treating our patients with corticosteroids. We compared these children (group 1) with those children treated in a similar manner, but without corticosteroids (group 2).

Results:  The two groups had similar ages, initial serum lactate dehydrogenase levels, and initial alveolar-arterial difference in partial pressure of oxygen. There was a significant (P<.0001) reduction in the need for mechanical ventilation and in mortality in the corticosteroid-treated group.

Conclusion:  Corticosteroid therapy during acute infection with P carinii in young children with AIDS appears to significantly reduce morbidity (as measured by the need for mechanical ventilation) and mortality.(Arch Pediatr Adolesc Med. 1994;148:638-641)