Successful Intermittent Prophylaxis With Trimethoprim/Sulfamethoxazole 2 Days per Week for Pneumocystis carinii (jiroveci) Pneumonia in Pediatric Oncology Patients

Abstract

Intermittent dosing of trimethoprim/sulfamethoxazole on 2 consecutive days per week is an effective alternative prophylactic regimen for P. carinii pneumonia in pediatric patients with leukemia and lymphoma. This analysis does not support a difference in neutropenia during maintenance therapy between patients who are treated with trimethoprim/sulfamethoxazole versus an alternative drug.

Intermittent oral trimethoprim/sulfamethoxazole on two non‐consecutive days per week is effective as Pneumocystis jiroveci pneumonia prophylaxis in pediatric patients receiving chemotherapy or hematopoietic stem cell transplantation

“…Although some children cannot tolerate TMP-SMZ due to myelosuppression according to other reports [16,17], only one patient (3%) stopped our regimen due to myelosuppression. Lindemulder and Albano [16] reported that the incidence of neutropenia was reduced with the regimen of two consecutive days per week (4.1%) as compared to the regimen of three consecutive days per week (5.8%) during maintenance days [8]. Given the plasma half-life of TMP (6-17 hr) [18,19], its plasma level was probably kept lower in our regimen than in the 2-dayconsecutive regimen, which might lead to a lower risk of adverse reactions while exerting the same efficacy for prevention of PCP.…”

“…It is known that lower-dose regimens are better tolerated [11]. Although some children cannot tolerate TMP-SMZ due to myelosuppression according to other reports [16,17], only one patient (3%) stopped our regimen due to myelosuppression. Lindemulder and Albano [16] reported that the incidence of neutropenia was reduced with the regimen of two consecutive days per week (4.1%) as compared to the regimen of three consecutive days per week (5.8%) during maintenance days [8].…”

“…Lindemulder and Albano [16] recently reported the efficacy of an intermittent PCP prophylaxis regimen with TMP-SMZ on two consecutive days per week in pediatric patients with leukemia and lymphoma. We also observed no breakthrough cases of PCP in patients with an intermittent TMP-SMZ prophylaxis regimen on 2 non-consecutive days per week, which indicates the efficacy of a twice-weekly regimen regardless of consecutiveness.…”

Cotrimoxazole myelotoxicity in hematopoietic SCT recipients: time for reappraisal

“…[1][2][3][4] Cotrimoxazole is known for myelotoxicity, [5][6][7][8] especially after long-term administration as prophylaxis in HIV patients, 9 and is therefore used cautiously after HSCT. The impact of this toxicity on neutrophil and platelet engraftment and duration of neutropenia/thrombocytopenia after allogeneic HSCT has not been determined.…”

Changing Microbiological Pattern of Pediatric Febrile Neutropenia

“…Another important paradigm in the management of pediatric FN is use of antibiotic prophylaxis. Primary prophylaxis for P. jirovecii pneumonia has decreased associated morbidity and mortality in children with FN [10]. Trimethoprim/sulfamethoxazole, amoxicillin/clavulanate and fluoroquinolones have been used as antibacterial prophylaxis in these children with success, but has been linked with the risk of emergence of antibiotic resistance [1].…”