雾化与静脉注射喷他脒对免疫抑制的儿科、青少年和青年成人患者预防耶氏肺孢子菌肺炎的耐受性
Tolerability of Aerosolized Versus Intravenous Pentamidine for Pneumocystis jirovecii Pneumonia Prophylaxis in Immunosuppressed Pediatric, Adolescent, and Young Adult Patients.
作者信息
Brown Kelsey S, Reed Michael D, Dalal Jignesh, Makii Melissa D
出版信息
J Pediatr Pharmacol Ther. 2020;25(2):111-116. doi: 10.5863/1551-6776-25.2.111.
OBJECTIVES
Pentamidine is an antifungal that is used alternatively to sulfamethoxazole-trimethoprim for the prophylaxis and treatment of Pneumocystis jirovecii pneumonia (PJP). The primary objective of this study was to assess the tolerability of aerosolized versus intravenous pentamidine for PJP prophylaxis in pediatric, adolescent, and young adult immunosuppressed patients. Secondary objectives included comparing pentamidine formulation reaction to dosing frequency and diagnosis.
METHODS
This retrospective chart review used electronic medical record (EMR) data from patients at a tertiary care pediatric teaching institution from January 1, 2014, to January 1, 2017. Information used from the EMR included pentamidine dosing, ordering, and laboratory values. Inclusion criteria consisted of patients with a cancer diagnosis, hematopoietic stem cell transplant (HSCT) recipients, and renal transplant recipients who received pentamidine for PJP prophylaxis.
RESULTS
Ninety-six patients met inclusion criteria, of which 31 received aerosolized pentamidine. Ten of the 96 patients experienced a drug-related reaction to either aerosolized or intravenous pentamidine (p = 0.134). Nine of 10 patients who experienced a reaction received intravenous pentamidine versus 1 patient who received aerosolized pentamidine (p = 0.132). In those patients who reacted to pentamidine there was a higher incidence of reactions after subsequent administration (p = 0.039) and in patients with a blood cancer diagnosis (p = 0.042).
CONCLUSIONS
Data suggest that patients who receive aerosolized pentamidine may tolerate therapy better compared to intravenous administration. Additional studies involving larger numbers of pediatric, adolescent, and young adult patients are needed for stronger statistically significant clinical differences in tolerability of aerosolized versus intravenous pentamidine.
目的
喷他脒是一种抗真菌药物，可替代磺胺甲恶唑-甲氧苄啶用于预防和治疗耶氏肺孢子菌肺炎（PJP）。本研究的主要目的是评估雾化吸入与静脉注射喷他脒在儿科、青少年和年轻成人免疫抑制患者中预防PJP的耐受性。次要目的包括比较喷他脒制剂反应与给药频率和诊断情况。
方法
这项回顾性病历审查使用了来自一家三级儿科教学机构2014年1月1日至2017年1月1日患者的电子病历（EMR）数据。EMR中使用的信息包括喷他脒的给药、医嘱和实验室值。纳入标准包括患有癌症诊断的患者、造血干细胞移植（HSCT）受者以及接受喷他脒预防PJP的肾移植受者。
结果
96名患者符合纳入标准，其中31名接受了雾化吸入喷他脒。96名患者中有10名对雾化吸入或静脉注射喷他脒出现药物相关反应（p = 0.134）。出现反应的10名患者中有9名接受了静脉注射喷他脒，而1名接受了雾化吸入喷他脒（p = 0.132）。在对喷他脒有反应的患者中，后续给药后反应发生率更高（p = 0.039），在患有血癌诊断的患者中也是如此（p = 0.042）。
结论
数据表明，与静脉给药相比，接受雾化吸入喷他脒的患者可能对治疗的耐受性更好。需要开展涉及更多儿科、青少年和年轻成人患者的进一步研究，以在雾化吸入与静脉注射喷他脒的耐受性方面得出更强的具有统计学意义的临床差异。
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