Single-Day Trimethoprim/Sulfamethoxazole Prophylaxis for Pneumocystis Pneumonia in Children with Cancer

The use of intravenous pentamidine for the prophylaxis of Pneumocystis pneumonia in pediatric patients

“…Even when considering this patient having had a true PCP infection, the breakthrough rate in our cohort is only 0.9% as comparable to other published data on efficacy of IVP (Supplementary Table S2), other second‐line agents, and cohorts with a smaller proportion of SCT patients . Efficacy, however, is less than what has been described for TMP–SMX with a breakthrough rate of 0.08–0.2% . IVP was well tolerated, as only two patients had to discontinue the course due to recurrent nausea after administration.…”

Question 1: Co-trimoxazole dosing dilemma: what is the right dose?

“…Apart from one study,17 therapy was administered on consecutive days. A large multicentre prospective cohort study over a 3 year period compared 5 mg/kg/day on 3 days, 5 or 10 mg/kg/day on 2 days and 5 or 10 mg/kg/day on 1 day/week 14. In this study, PJP was observed in two children, one who was non-adherent to a 2 days/week regimen, and another child who ceased co-trimoxazole prophylaxis due to adverse effects.…”

“…Our search identified 11 studies: four randomised-controlled trials (RCT) including two placebo-controlled,1 11–13 two prospective2 14 and five retrospective cohort studies 15–19. Four studies included only patients with acute lymphoblastic leukaemia11–13 18 while the remainder included children with a range of haematological malignancies and solid tumours.…”

“…Subsequent studies examined intermittent regimens, ie 1, 2 or 3 days/week 14 16–19. Apart from one study,17 therapy was administered on consecutive days.…”

Failures of once‐a‐week trimethoprim‐sulfamethoxazole prophylaxis in children undergoing allogeneic hematopoietic stem cell transplant

“…In recent years, an Italian survey showed that once‐a‐week TMP‐SMX was sufficient for prevention of PJP in children receiving antineoplastic chemotherapy, reducing the number of drugs administered to each patients, and consequently improving compliance . In 2014, we adopted this strategy to all children receiving antineoplastic chemotherapy, autologous, or allogeneic SCT at the IRCCS Istituto Giannina Gaslini, Genoa—Italy.…”