Pentamidine for Prophylaxis against Pneumocystis jirovecii Pneumonia in Pediatric Oncology Patients Receiving Immunosuppressive Chemotherapy

Abstract

pneumonia is a life-threatening opportunistic infection in children receiving immunosuppressive chemotherapy. Without prophylaxis, up to 25% of pediatric oncology patients receiving chemotherapy will develop pneumonia. Trimethoprim-sulfamethoxazole is the preferred agent for prophylaxis against pneumonia. Pentamidine may be an acceptable alternative for pediatric patients unable to tolerate trimethoprim-sulfamethoxazole. A retrospective review was conducted of pediatric oncology patients who received ≥1 dose of pentamidine for pneumonia prophylaxis between January 2007 and August 2014. Electronic medical records were reviewed to determine the incidence of breakthrough pneumonia or discontinuation of pentamidine associated with adverse events. A total of 754 patients received pentamidine prophylaxis during the period. There were no cases of probable or proven pneumonia, and 4 cases (0.5%) of possible pneumonia. The incidence of possible breakthrough pneumonia was not significantly different between subgroups based on age (<12 months [1.7%] versus ≥12 months [0.4%], = 0.3), route of administration (aerosolized [0%] versus intravenous [1.0%], = 0.2), or hematopoietic stem cell transplant status (transplant [0.4%] versus no transplant [0.8%], = 0.6). Pentamidine was discontinued due to an adverse drug event in 23 children (3.1%), more frequently for aerosolized than for intravenous administration (7.6% versus 2.2%, respectively, = 0.004). Intravenous or inhaled pentamidine may be a safe and effective second-line alternative for prophylaxis against pneumonia in children with cancer receiving immunosuppressive chemotherapy or hematopoietic stem cell transplantation.

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

“…The study population in the prospective study consisted of adults who had undergone HSCT or had received only intensive chemotherapy, and the retrospective study included only patients who had undergone allogeneic HSCT patients. These findings are consistent with those reported in the literature in pediatric HSCT population [11,13,17,18]. However, a concern toward an increased risk of breakthrough PCP infection in younger patients receiving IVP as PCP prophylaxis was reported in the pediatric population [11].…”

Using Routine Laboratory Markers and Immunological Indicators for Predicting Pneumocystis jiroveci Pneumonia in Immunocompromised Patients

“…Recently, more and more PJP patients are reported in HIV-negative patients, with the increase of using immunosuppressants in clinical practice ( 23 , 24 ). However, which laboratory indicators can be used to predict the development of PJP in patients during immunosuppressive treatment remains obscure, and the answer to this is obviously critical to timely prophylaxis and improving mortality ( 25 ). In this study, after matching age, gender, immunosuppressant exposure, and underlying conditions or illnesses, we compared the characteristics of routine laboratory tests and immunological indicators of patients with PJP to those of patients with non-PJP.…”

Seroprevalence and risk factors of Toxoplasma gondii infection in children with leukemia in Shandong Province, Eastern China: a case—control prospective study

“…Although further studies should be conducted to explore the causation between T. gondii infection and blood transfusion in leukemia patients, it is a pressing matter of the moment to encourage medical professionals to pay attention to the important role that exposure to soil and blood transfusion play in transmitting T. gondii infection to leukemia patients, and to test T. gondii routinely before donor blood is infused to patients. Moreover, a recent study conducted by Quinn et al (2018) suggested that pentamidine effectively prevents Pneumocystis jirovecii pneumonia in pediatric oncology patients receiving immunosuppressive chemotherapy. Children with leukemia are immunosuppressive and struggle to resist parasite infections.…”