From the *Children's Medical Center Dallas, Dallas, TX; †Huntsville Hospital for Women and Children, Huntsville, AL; and ‡University of Texas Southwestern Medical Center, Dallas, TX.
Pediatr Infect Dis J. 2013 Sep;32(9):933-6. doi: 10.1097/INF.0b013e318292f560.
Pneumocystis carinii pneumonia (PCP) is a potentially life-threatening but preventable infection that may occur after hematopoietic stem cell transplantation (HSCT). Intravenous pentamidine has been used in the prevention of PCP in the post-transplant period, although there are few trials published in the literature evaluating its safety and efficacy.
We retrospectively reviewed the medical records of children who underwent HSCT from January 1, 2005, to October 1, 2011, who received intravenous pentamidine as first-line PCP prophylaxis initiated at admission. Demographic, clinical, microbiologic, management and outcome data were collected.
One hundred sixty-seven consecutive HSCTs in 137 pediatric patients were given intravenous pentamidine before myeloablation and then every 28 days until the subject was at least a minimum 30 days post-HSCT, had stable neutrophil engraftment (absolute neutrophil count >1000/mm for 3 days without growth factor support) and for allogeneic patients, no evidence of active graft versus host disease and weaning on their immunosuppressive therapy. No cases of PCP were seen in this cohort. Ten (7%) had a grade I side effect of nausea/vomiting requiring slower infusion time and 2 (2%) had a grade IV reaction with anaphylaxis (rash) and hypotension with 1 child requiring transfer to the intensive care unit.
Intravenous pentamidine was safe and effective for the prevention of PCP in pediatric HSCT patients. Given the potential neutropenic effects of trimethoprim-sulfamethoxazole, compliance with drug administration and inferior efficacy of other PCP prophylactic medications, intravenous pentamidine should be considered as first-line therapy for the prevention of PCP in children undergoing HSCT.
卡氏肺孢子虫肺炎（PCP）是一种潜在的致命但可预防的感染，可能发生在造血干细胞移植（HSCT）后。静脉注射喷他脒已被用于移植后时期预防 PCP，但文献中发表的评估其安全性和疗效的试验很少。
我们回顾性地审查了 2005 年 1 月 1 日至 2011 年 10 月 1 日期间接受 HSCT 的儿童的病历，这些儿童在入院时接受了静脉注射喷他脒作为一线 PCP 预防药物，开始预防。收集了人口统计学、临床、微生物学、管理和结果数据。
在 137 例儿科患者中，167 例连续接受 HSCT，在骨髓清除前给予静脉注射喷他脒，然后每 28 天一次，直至患者至少在 HSCT 后 30 天，中性粒细胞植入稳定（无生长因子支持的情况下连续 3 天绝对中性粒细胞计数>1000/mm），对于同种异体患者，无活动性移植物抗宿主病证据，并逐渐减少免疫抑制治疗。在该队列中未发现 PCP 病例。10 例（7%）出现 I 级恶心/呕吐副作用，需要减慢输注速度，2 例（2%）出现 IV 级过敏反应（皮疹）和低血压，其中 1 例需要转入重症监护病房。
静脉注射喷他脒对预防儿科 HSCT 患者的 PCP 是安全有效的。鉴于复方磺胺甲噁唑可能具有潜在的中性粒细胞减少作用，药物管理的依从性以及其他 PCP 预防药物的疗效较差，静脉注射喷他脒应被视为预防接受 HSCT 的儿童发生 PCP 的一线治疗方法。
