Effectiveness and tolerability of intravenous pentamidine for Pneumocystis carinii pneumonia prophylaxis in adult hematopoietic stem cell transplant patients: a retrospective study

Abstract

Background: Pneumocystis carinii pneumonia (PCP) prophylaxis is recommended after hematopoietic stem cell transplantation (HSCT). In patients who are unable to take first-line prophylaxis, trimethoprim/sulfamethoxazole, aerosolized pentamidine is recommended. This drug may not, however, be available at all institutions, and its administration requires special techniques. Therefore, intravenous pentamidine (IVP) has been used in adult patients as an alternative, despite limited data. We evaluated the effectiveness and tolerability of IVP for PCP prophylaxis in adult patients who had undergone HSCT. Methods: A single-center retrospective study was conducted of adult patients who had undergone allogenic or autologous HSCT between January 2014 and September 2018 and had received at least three doses of IVP for PCP prophylaxis. The IVP dose was 4 mg/kg administered monthly. Data on PCP infection and adverse reactions were collected from both patients' electronic medical records and the pharmacy adverse drug reactions documentation system. Patients were followed from the start of IVP up to 6 months after discontinuation of therapy. A confirmed PCP infection was defined as radiographic evidence of PCP and positive staining of a respiratory specimen. Descriptive statistics were used to analyze the study outcomes. Results: During the study period, 187 patients were included. The median age was 36.4 years (range, 18-64), 58% were male, and 122 (65%) had received allogeneic HSCT while the remainder autologous HSCT. The median number of IVP doses administered per patient was 5 (range, 3-29). During the study period, none of the patients had evidence of confirmed PCP infection. However; there were two cases with high clinical suspicion of PCP infection (i.e. required anti-pneumocystis therapy) and one reported case of central nervous system toxoplasmosis while receiving IVP for PCP prophylaxis. Only one case of nausea associated with IVP administration was reported.

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“…6 , 18 , 19 In patients who had serious ADRs to co-trimoxazole or other sulfa-drugs, either dapsone 100 mg daily or intravenous pentamidine 300 mg monthly could be used as an alternative for PCP prophylaxis. 20 , 21 Moreover, clindamycin 600 mg plus primaquine 30 mg for 21 days could be used as the treatment of PCP. 22…”

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“…95 Dapsone or atovaquone given once per day and aerosolized or IV pentamidine given once per month are thought to be effective alternatives to TMP/SMX, although some data suggest that these agents may be inferior when used prophylactically in recipients of allo-SCT. [96][97][98][99] A common practice among institutions is continuing PJP prophylaxis for 6 months to a year or until immunosuppressive therapy is completed (Table 3).…”