       Document 0668
 DOCN  M9620668
 TI    Atovaquone. A review of its pharmacological properties and therapeutic
       efficacy in opportunistic infections.
 DT    9602
 AU    Spencer CM; Goa KL; Adis International Limited, Auckland, New Zealand.
 SO    Drugs. 1995 Jul;50(1):176-96. Unique Identifier : AIDSLINE MED/96078265
 AB    Atovaquone has been investigated as an alternative agent for oral use in
       the treatment of both mild to moderate Pneumocystis carinii pneumonia
       (PCP) and toxoplasmosis, opportunistic infections commonly experienced
       by patients with AIDS. In patients with mild to moderate PCP, a dosage
       of 750mg 3 times daily (administered in tablet form) has similar overall
       therapeutic efficacy (defined as clinical response without a
       treatment-limiting adverse event) to the conventional therapies oral
       cotrimoxazole (trimethoprim-sulfamethoxazole) and intravenous
       pentamidine, respectively. Response rates to atovaquone are lower than
       those achieved with cotrimoxazole, but atovaquone has superior
       tolerability. Atovaquone recipients experienced significantly fewer
       treatment-limiting adverse effects than patients treated with
       cotrimoxazole (7 vs 20%) or pentamidine (4 vs 36%). Mortality rates were
       higher among atovaquone-treated patients than in cotrimoxazole
       recipients (7 vs 0.6%) 4 weeks after completion of therapy in a large
       comparative trial, although most deaths were caused by bacterial
       infections. However, a similar rate of mortality was reported for
       atovaquone- and pentamidine-treated patients (16 vs 17% 8 weeks after
       discontinuation of therapy) in another study. In predominantly small
       numbers of patients with toxoplasmosis, of whom most were unresponsive
       to conventional agents, atovaquone 750mg 4 times daily (administered as
       tablets) produced a complete or partial radiological response rate of 37
       to 87.5% 52% of patients achieved a complete or partial clinical
       response after 6 weeks of treatment in the largest trial (n = 87),
       although the incidence of toxoplasmosis-related death was 24% 18 weeks
       after therapy was initiated. Thus, atovaquone will be a useful option
       for the treatment of patients with mild to moderate PCP who are
       intolerant or unresponsive to cotrimoxazole, especially if the increased
       plasma drug concentrations observed with the suspension further improve
       response rates. Atovaquone should also be considered a promising agent
       for the treatment of toxoplasmosis.
 DE    Antifungal Agents/*PHARMACOLOGY/PHARMACOKINETICS/THERAPEUTIC USE
       Antiprotozoal Agents/*PHARMACOLOGY/PHARMACOKINETICS/THERAPEUTIC  USE
       AIDS-Related Opportunistic Infections/*DRUG THERAPY  Clinical Trials
       Drug Evaluation  Drug Interactions  Human
       Naphthoquinones/*PHARMACOLOGY/PHARMACOKINETICS/THERAPEUTIC USE
       Pneumonia, Pneumocystis carinii/*DRUG THERAPY/MORTALITY
       Toxoplasmosis/*DRUG THERAPY  JOURNAL ARTICLE  REVIEW  REVIEW, TUTORIAL

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

