Low-Dose vs Conventional-Dose Trimethoprim-Sulfamethoxazole Treatment for Pneumocystis Pneumonia in Patients Not Infected With HIV

Nagai, Tatsuo; Matsui, Hiroki; Fujioka, Haruka; Homma, Yuya; Otsuki, Ayumu; Ito, Hiroyuki; Ohmura, Shin-Ichiro; Miyamoto, Toshiaki; Shichi, Daisuke; Watari, Tomohisa; Otsuka, Yoshihito; Nakashima, Kei

doi:10.1016/j.chest.2023.08.009

Cited by 6 publications

(1 citation statement)

References 36 publications

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“…Although the efficacy of TMP/SMX is established, it carries a significant risk of adverse events affecting the gastrointestinal, renal, hepatic, and hematologic systems. Nagai et al recently assessed the efficacy and safety of low-dose TMP/SMX (TMP <12.5 mg/kg/day) for non-HIV PCP relative to conventional-dose TMP/SMX (TMP 12.5-20 mg/kg/day), accounting for patient demographic characteristics [12]. In the group receiving a lower dosage, the mean administration of TMP was 8.71 mg/kg/day, whereas it was 17.78 mg/kg/day in the group receiving the standard dosage.…”

Section: Discussionmentioning

confidence: 99%

A Case of Pneumocystis Pneumonia Developed During Rheumatoid Arthritis Treatment With Methotrexate and Golimumab

Yanagihara,

Oka,

Moriwaki

et al. 2024

Cureus

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Here, we report a case of an 87-year-old female patient with rheumatoid arthritis (RA) treated with methotrexate (MTX) and golimumab who developed severe pneumocystis pneumonia (PCP), also known as Pneumocystis jirovecii pneumonia. The patient presented with chief complaints of dyspnea on exertion, dry cough, and fatigue. A high-resolution chest CT scan revealed diffuse, unevenly distributed ground-glass opacities throughout both lungs. The patient was clinically diagnosed with PCP based on the clinical settings, imaging, and a high level of serum β-D-glucan. While the patient required high-flow oxygen therapy, low-dose trimethoprim/sulfamethoxazole and corticosteroid therapy improved her condition, and the patient was discharged on day 25. Although to our knowledge no case report has been published regarding PCP in patients with RA treated with golimumab, this case emphasizes the importance of attention to opportunistic infections in elderly patients receiving immunosuppressive therapy. MTX use alongside tumor necrosis factor inhibitors like golimumab may increase the risk of serious infections such as PCP. The case underscores the necessity of prophylactic measures and early intervention for PCP, highlighting the delicate balance between immunosuppression benefits and infection risks in RA management.

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Section: Discussionmentioning

confidence: 99%