Combination of Echinocandins and Trimethoprim/Sulfamethoxazole for the Treatment of Pneumocystis jiroveci Pneumonia After Heart Transplantation

Lu, Y.-M.; Lee, Y.-T.; Chang, H.-C.; Yang, Hou-Sheng; Chang, Chung Yi; Huang, Chung‐Hao; Wei, Jeng

doi:10.1016/j.transproceed.2017.04.020

Cited by 15 publications

(13 citation statements)

References 20 publications

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“…The early application of a combined echinocandins/TMP-SMX treatment for mild AIDS-PCP patients could significantly reduce the mortality rate compared to TMP-SMX treatment alone (4.44% vs. 18.18%, P < 0.05). These findings are consistent with some case reports suggesting that echinocandins could improve the prognosis of patients with PCP [11–13]. In addition, the feasibility of combined echinocandins/TMP-SMX treatment for PCP was demonstrated in studies of PCP animal models and in vitro experiments [19–21].…”

Section: Discussionsupporting

confidence: 90%

“…Caspofungin is an antifungal agent that acts on spore cysts by inhibiting the synthesis of β -(1,3)-D-glucan [10]. Lee et al, Li et al, and Lu et al observed that echinocandins in combination with TMP-SMX treatment can improve the prognosis of PCP patients and decrease the associated mortality rate [11–13]. However, there has been little investigation of these effects in AIDS-PCP patients.…”

Section: Introductionmentioning

confidence: 99%

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A Pilot Study of Echinocandin Combination with Trimethoprim/Sulfamethoxazole and Clindamycin for the Treatment of AIDS Patients with Pneumocystis Pneumonia

Wang

Lang

Chen

et al. 2019

Journal of Immunology Research

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Background and Objectives Pneumocystis pneumonia (PCP) is a common opportunistic infection in acquired immune deficiency syndrome (AIDS) patients that continues to result in a high mortality rate. To develop a better treatment strategy and improve PCP prognosis, a cohort study was conducted to evaluate the therapeutic potential of echinocandin treatment for AIDS patients with PCP (AIDS-PCP). Methods The AIDS-PCP patients were analyzed in our retrospective cohort study that were hospitalized in The First Affiliated Hospital of Zhejiang University during 2013–2018. The antifungal effects of echinocandins were evaluated in two subgroups that were classified by oxygenation as a proxy for the disease state: PaO2/FiO2 > 200 mmHg and PaO2/FiO2 ≤ 200 mmHg. Intergroup comparisons and survival curves were used to evaluate the effectiveness of the two AIDS-PCP treatment regimens. Results During the follow-up, 182 AIDS-PCP patients were diagnosed and analyzed in the study. After excluding 55 patients with other superinfections and five patients that were treated with HAART, the remaining 122 patients were enrolled in the study. The group treated with echinocandins combined with trimethoprim-sulfamethoxazole (TMP-SMZ) and clindamycin exhibited a lower mortality rate (9.62%, 5/52) than did the group with TMP-SMZ and clindamycin treatment (20%, 14/70). For AIDS-PCP patients in the PaO2/FiO2 > 200 mmHg subgroup, treatment with echinocandins combined with TMP-SMZ and clindamycin significantly reduced their mortality rate (4.44% (2/45) vs. 18.18% (10/55), P = 0.035). Conclusion The results of this study indicate that treatment with echinocandins in combination with the standard TMP-SMZ and clindamycin regimen can improve the prognosis and reduce the mortality rate in patients with mild to moderate AIDS-PCP disease.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

A Pilot Study of Echinocandin Combination with Trimethoprim/Sulfamethoxazole and Clindamycin for the Treatment of AIDS Patients with Pneumocystis Pneumonia

Wang

Lang

Chen

et al. 2019

Journal of Immunology Research

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“…Subsequently, the full-text review of 22 articles was performed. Of these, 18 articles were further excluded on the basis of the exclusion criteria listed in Figure 1 , leaving four studies that met eligibility for the meta-analysis [ 11 , 12 , 13 , 14 ].…”

Section: Resultsmentioning

confidence: 99%

“…The characteristics of these four studies, all of which were conducted at single centers, are summarized in Table 1 . One was a case-control study conducted in Taiwan [ 11 ], and the other three were cohort studies undertaken in China [ 12 , 13 , 14 ]. The participants reported by Lu et al [ 11 ] were heart transplant recipients, whereas those in the cohort studied by Jin et al [ 12 ] were non-HIV-infected patients.…”

Section: Resultsmentioning

confidence: 99%

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Efficacy of Trimethoprim–Sulfamethoxazole in Combination with an Echinocandin as a First-Line Treatment Option for Pneumocystis Pneumonia: A Systematic Review and Meta-Analysis

et al. 2022

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Although combination therapy using trimethoprim–sulfamethoxazole (TMP–SMX) plus echinocandins has been reported to reduce the mortality of patients with pneumocystis pneumonia (PCP), it remains unclear whether it is more effective than TMP–SMX monotherapy, the current first-line treatment for this disease. Hence, we performed a systematic review and meta-analysis to compare the efficacies of these treatment options for PCP. The Scopus, EMBASE, PubMed, CINAHL, and Ichushi databases were searched for studies (up to January 2022) reporting the mortality and positive response rates (fewer clinical symptoms, improved partial pressure of arterial oxygen, and resolution of pneumonitis on chest imaging) of PCP patients receiving monotherapy or combination therapy. Four studies met the inclusion criteria. All four presented mortality data and one had positive response rates. Compared with the monotherapy, the combination therapy resulted in significantly lower mortality and higher positive response rates (mortality: odds ratio (OR) 2.20, 95% confidence interval (CI) 1.46–3.31; positive response rate: OR 2.13, 95%CI 1.41–3.23), suggesting it to be an effective and promising first-line therapy for PCP. However, further safety evaluations are needed to establish this as a fact.

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Neurological and Psychiatric Side Effects of Antimicrobials

Bangert

Hasbun

2020

Current Clinical Neurology

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Combination of Echinocandins and Trimethoprim/Sulfamethoxazole for the Treatment of Pneumocystis jiroveci Pneumonia After Heart Transplantation

Cited by 15 publications

References 20 publications

A Pilot Study of Echinocandin Combination with Trimethoprim/Sulfamethoxazole and Clindamycin for the Treatment of AIDS Patients with Pneumocystis Pneumonia

A Pilot Study of Echinocandin Combination with Trimethoprim/Sulfamethoxazole and Clindamycin for the Treatment of AIDS Patients with Pneumocystis Pneumonia

Efficacy of Trimethoprim–Sulfamethoxazole in Combination with an Echinocandin as a First-Line Treatment Option for Pneumocystis Pneumonia: A Systematic Review and Meta-Analysis

Neurological and Psychiatric Side Effects of Antimicrobials

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