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Open Access Publications from the University of California

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.

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© 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.

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