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Intravenous pentamidine is effective as second line Pneumocystis pneumonia prophylaxis in pediatric oncology patients
Author(s) -
Kim Su Young,
Dabb Alix A.,
Glenn Donald J.,
Snyder Kristen M.,
Chuk Meredith K.,
Loeb David M.
Publication year - 2008
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.21287
Subject(s) - medicine , pentamidine , pneumonia , retrospective cohort study , pneumocystis carinii , pneumocystis jirovecii , trimethoprim , surgery , pediatrics , antibiotics , microbiology and biotechnology , biology
Background Pneumocystis jirovecii , formerly carinii , pneumonia (PCP) poses a life‐threatening risk to oncology patients. The use of trimethoprim‐sulfamethoxazole (TMP‐SMZ) prophylaxis virtually eliminates the risk of infection; however, many patients cannot tolerate TMP‐SMZ. We performed a retrospective analysis to determine the PCP breakthrough rate in pediatric oncology patients receiving intravenous pentamidine as second line PCP prophylaxis. Procedure We conducted a retrospective chart review of pediatric oncology patients who received intravenous pentamidine from 2001 to 2006 at our institution. The diagnosis, age and bone marrow transplant (BMT) status were determined. A subset of patients had review of their records to determine the justification for discontinuing TMP‐SMZ. Children who developed symptoms of pneumonia with a clinical suspicion of PCP underwent bronchoscopy, allowing for identification of Pneumocystis . Results A total of 232 patients received 1,706 doses of intravenous pentamidine and no toxicities were identified. The main reasons for discontinuing TMP‐SMZ were bone marrow suppression and drug allergy. Three children developed PCP, equating to a breakthrough rate of 1.3%. Two of these children had undergone BMT (1.9% breakthrough rate) and both were under the age of two (6.5% breakthrough rate). Conclusions The use of intravenous pentamidine as PCP prophylaxis results in a breakthrough rate of 1.3%. TMP‐SMZ is the first choice for PCP prophylaxis. However, when necessary, the use of intravenous pentamidine has an acceptably low failure rate, even in high‐risk BMT patients. Other options should be considered for children less than 2 years of age. Pediatr Blood Cancer 2008;50:779–783. © 2007 Wiley‐Liss, Inc.