Pentamidine isethionate is an antiparasitical/antiprotozoal drug primarily given for prevention and treatment of Pneumocystis jiroveci pneumonia, also formerly known as Pneumocystis carinii pneumonia (PCP), a type of pneumonia often seen in patients with HIV infection. PCP is considered an 'opportunistical infection', endagering only immunecompromised patients such as those with HIV/AIDS-infection. The mortality of untreated PCP is very high. Additionally, Pentamidine has good clinical activity against the parasites causing Leishmaniasis. Sleeping sickness caused by different strains of Trypanosoma is another indication. The exact nature of its antiprotozoal action is unknown. The drug has also activity against candida albicans in clinically relevant concentrations. In the US Pentamidine is currently designated an orphan drug by the FDA.

Treatment of acute PCP

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In the acute treatment of PCP Pentamidine is considered equally or slightly less active compared to co-trimoxazole (brand names Bactrim, Septrin, or Septra). Clinical evidence suggests that Pentamidine is often better tolerated than co-trimoxazole because a high dose of co-trimoxazol is needed, which is associated with a high incidence and severity of side effects (hepatitis, bone-marrow-damage, renal-damage, and life threatening skin disease (Lyell-syndrome)). Moreover, many patients are or become hypersensitive to co-trimoxazole. For treatment of PCP, 4mg of Pentamidine per kg of body weight is given intravenously once daily for 14 to 21 days. Treatment exceeding 21 days may be necessary but associated with increased toxicity. I.M.-Injection is not recommended. The effect of Pentamidine often becomes evident within the first 2 days of treatment as defeverescence and improvement of respiratory function. In any case, improvements of X-Ray studies occur within 6 to 8 days, provided therapy is successful. Pentamidine therapy cures 50 to 70% of all patients treated.

Primary and Secondary Prophylaxis of PCP

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Primary prophylaxis means that so far no PCP has been diagnostized. Secondary prophylaxis aims to prevent further PCP. For both forms of prophylaxis an aerosolized formulation given by nebulizer once monthly in a dose of 300mg exists. In primary prophylaxis this reduces the longterm likelihood of PCP by 70% compared to no prophylaxis.

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