Safe and Effective Prophylaxis with Bi-Monthly Intravenous Pentamidine in the Pediatric Hematopoietic Stem Cell Transplant Population
- Author(s): Levy, ER
- Musick, L
- Zinter, MS
- Lang, T
- Cowan, MJ
- Weintrub, PS
- Dvorak, CC
- et al.
Published Web Locationhttp://10.0.4.73/INF.0000000000000946
© 2015 Wolters Kluwer Health, Inc. All rights reserved. BACKGROUND:: Without prophylaxis, Pneumocystis jiroveci pneumonia (PCP) develops in 5-15% of pediatric hematopoietic stem cell transplant (HCT) patients with mortality above 50%. Trimethoprim-sulfamethoxazole (TMP-SMZ) is standard PCP prophylaxis; pentamidine is frequently used as second-line prophylaxis due to TMP-SMZ’s potential for cytopenias. Monthly IV pentamidine has variable efficacy with PCP infection rates of 0-10% in pediatric patients, and higher breakthrough rates in those <2 years old. We hypothesized that bi-monthly (twice monthly) pentamidine might have equivalent safety and improved efficacy; therefore, we conducted a retrospective analysis of bi-monthly pentamidine PCP prophylaxis. METHODS:: We retrospectively reviewed records of all pediatric HCT patients who received bi-monthly IV pentamidine between December 2006-June 2013 and collected data regarding demographics, clinical course, prophylaxis rationale, laboratory values, and adverse events. RESULTS:: Between December 2006 and June 2013, 111 pediatric HCT patients received bi-monthly IV pentamidine (574 doses, 8758 patient-days); 31 patients were under 2 years old at initiation. In the majority (53% of courses) pentamidine was initiated because of cytopenias. Fourteen patients (12.6% of patients, 2.4% of doses) experienced a side effect prompting discontinuation; including 3 patients with infusion-related hypotension/anaphylaxis and 3 with acute pancreatic dysfunction. No patients (0%, [CI 0-3.2%] developed PCP during or following bi-monthly IV pentamidine prophylaxis. CONCLUSIONS:: Bi-monthly IV pentamidine for PCP prophylaxis in the HCT pediatric population has comparable safety to monthly IV pentamidine and was highly effective, including in the very young. Bi-monthly IV Pentamidine should be considered in pediatric patients as second line PCP prophylaxis.
Many UC-authored scholarly publications are freely available on this site because of the UC Academic Senate's Open Access Policy. Let us know how this access is important for you.