Levy Emily R, Musick Lisa, Zinter Matthew S, Lang Tess, Cowan Mort J, Weintrub Peggy S, Dvorak Christopher C
From the *Division of General Pediatrics, †Division of Pediatric Allergy, Immunology, and Blood and Marrow Transplant, and ‡Division of Pediatric Critical Care, University of California San Francisco Benioff Children's Hospital, San Francisco, California; §Valley Family Medicine, University of Washington, Seattle, Washington; and ¶Division of Infectious Disease, University of California San Francisco Benioff Children's Hospital, San Francisco, California.
Pediatr Infect Dis J. 2016 Feb;35(2):135-41. doi: 10.1097/INF.0000000000000946.
Without prophylaxis, Pneumocystis jiroveci pneumonia (PCP) develops in 5%-15% of pediatric hematopoietic stem cell transplant (HCT) patients with mortality above 50%. Trimethoprim-sulfamethoxazole is a standard PCP prophylaxis; pentamidine is frequently used as second-line prophylaxis because of trimethoprim-sulfamethoxazole's potential for cytopenias. Monthly intravenous (IV) pentamidine has variable efficacy with PCP infection rates of 0%-10% in pediatric patients, and higher breakthrough rates in those younger than 2 years. We hypothesized that bimonthly (twice monthly) pentamidine might have equivalent safety and improved efficacy; therefore, we conducted a retrospective analysis of bimonthly pentamidine PCP prophylaxis.
We retrospectively reviewed records of all pediatric HCT patients who received bimonthly IV pentamidine between December 2006 and June 2013, and collected data regarding demographics, clinical course, prophylaxis rationale, laboratory values and adverse events.
Between December 2006 and June 2013, 111 pediatric HCT patients received bimonthly IV pentamidine (574 doses, 8758 patient-days); 31 patients were younger than 2 years 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% (95% confidence interval: 0-3.2)] developed PCP during or after bimonthly IV pentamidine prophylaxis.
Bimonthly 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. Bimonthly IV pentamidine should be considered in pediatric patients as second-line PCP prophylaxis.
在未进行预防的情况下，5% - 15%的儿童造血干细胞移植（HCT）患者会发生耶氏肺孢子菌肺炎（PCP），死亡率超过50%。甲氧苄啶 - 磺胺甲恶唑是标准的PCP预防用药；由于甲氧苄啶 - 磺胺甲恶唑有导致血细胞减少的可能性，喷他脒常被用作二线预防用药。每月静脉注射（IV）喷他脒的疗效不一，儿童患者的PCP感染率为0% - 10%，2岁以下儿童的突破性感染率更高。我们推测每两个月（每月两次）使用喷他脒可能具有同等安全性且疗效更佳；因此，我们对每两个月使用一次喷他脒预防PCP进行了回顾性分析。
我们回顾性审查了2006年12月至2013年6月期间所有接受每两个月一次静脉注射喷他脒的儿童HCT患者的记录，并收集了有关人口统计学、临床病程、预防理由、实验室检查值和不良事件的数据。
2006年12月至2013年6月期间，111例儿童HCT患者接受了每两个月一次的静脉注射喷他脒（574剂，8758患者 - 日）；31例患者开始用药时年龄小于2岁。在大多数疗程（53%）中，因血细胞减少开始使用喷他脒。14例患者（占患者的12.6%，占剂量的2.4%）出现副作用并停药，包括3例与输液相关的低血压/过敏反应患者和3例急性胰腺功能障碍患者。在每两个月一次静脉注射喷他脒预防期间或之后，没有患者发生PCP[0%（95%置信区间：0 - 3.2）]。
在儿童HCT人群中，每两个月一次静脉注射喷他脒预防PCP的安全性与每月一次静脉注射喷他脒相当，且非常有效，包括对非常年幼的儿童。对于儿童患者，应考虑将每两个月一次静脉注射喷他脒作为二线PCP预防用药。
