Department of Pharmacy, King Hussein Cancer Center, P.O. Box 1269, Al-Jubeiha, Amman, 11941, Jordan.
BMC Infect Dis. 2020 Jun 5;20(1):400. doi: 10.1186/s12879-020-05127-y.
Pneumocystis carinii pneumonia (PCP) prophylaxis is recommended after hematopoietic stem cell transplantation (HSCT). In patients who are unable to take first-line prophylaxis, trimethoprim/sulfamethoxazole, aerosolized pentamidine is recommended. This drug may not, however, be available at all institutions, and its administration requires special techniques. Therefore, intravenous pentamidine (IVP) has been used in adult patients as an alternative, despite limited data. We evaluated the effectiveness and tolerability of IVP for PCP prophylaxis in adult patients who had undergone HSCT.
A single-center retrospective study was conducted of adult patients who had undergone allogenic or autologous HSCT between January 2014 and September 2018 and had received at least three doses of IVP for PCP prophylaxis. The IVP dose was 4 mg/kg administered monthly. Data on PCP infection and adverse reactions were collected from both patients' electronic medical records and the pharmacy adverse drug reactions documentation system. Patients were followed from the start of IVP up to 6 months after discontinuation of therapy. A confirmed PCP infection was defined as radiographic evidence of PCP and positive staining of a respiratory specimen. Descriptive statistics were used to analyze the study outcomes.
During the study period, 187 patients were included. The median age was 36.4 years (range, 18-64), 58% were male, and 122 (65%) had received allogeneic HSCT while the remainder autologous HSCT. The median number of IVP doses administered per patient was 5 (range, 3-29). During the study period, none of the patients had evidence of confirmed PCP infection. However; there were two cases with high clinical suspicion of PCP infection (i.e. required anti-pneumocystis therapy) and one reported case of central nervous system toxoplasmosis while receiving IVP for PCP prophylaxis. Only one case of nausea associated with IVP administration was reported.
In a cohort of adult patients with HSCT who received IVP for PCP prophylaxis, there was no evidence of confirmed PCP infection, and the treatment appeared to be well tolerated. Prospective studies should be conducted to confirm the efficacy and tolerability of IVP.
造血干细胞移植（HSCT）后推荐使用预防用复方磺胺甲噁唑（trimethoprim/sulfamethoxazole，TMP/SMZ）预防卡氏肺孢子菌肺炎（PCP）。对于无法接受一线预防的患者，推荐使用雾化喷他脒预防 PCP。然而，并非所有机构都能提供这种药物，而且其给药需要特殊技术。因此，静脉滴注喷他脒（intravenous pentamidine，IVP）已被用于成年患者作为替代药物，尽管数据有限。我们评估了 IVP 用于接受 HSCT 的成年患者 PCP 预防的有效性和耐受性。
对 2014 年 1 月至 2018 年 9 月间接受异基因或自体 HSCT 且至少接受 3 剂 IVP 预防 PCP 的成年患者进行单中心回顾性研究。IVP 剂量为 4mg/kg，每月 1 次。PCP 感染和不良反应的数据来自患者的电子病历和药房药物不良反应文档系统。从开始使用 IVP 到停止治疗后 6 个月对患者进行随访。确诊的 PCP 感染定义为影像学证据显示 PCP 合并呼吸道标本阳性染色。采用描述性统计分析研究结果。
研究期间纳入 187 例患者。中位年龄为 36.4 岁（范围为 18-64 岁），58%为男性，122 例（65%）接受异基因 HSCT，其余为自体 HSCT。每位患者接受的 IVP 剂量中位数为 5 剂（范围为 3-29 剂）。研究期间，患者均无确诊的 PCP 感染证据。然而，有 2 例患者有 PCP 感染的高度临床疑似病例（即需要抗肺孢子菌治疗），1 例在接受 IVP 预防 PCP 期间报告了中枢神经系统弓形虫病。仅报告了 1 例与 IVP 给药相关的恶心病例。
在接受 IVP 预防 PCP 的 HSCT 成年患者队列中，没有证据表明存在确诊的 PCP 感染，并且治疗似乎耐受性良好。应开展前瞻性研究以确认 IVP 的疗效和耐受性。
