Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
J Pharm Pharm Sci. 2021;24:220-226. doi: 10.18433/jpps31488.
It is hard for clinicians to choose the best regimen for pneumocystis jirovecii pneumonia (PJP) prophylaxis. The aim is to evaluate the effectiveness and safety of thrice weekly double strength (TWDS) vs daily single strength (DSS) trimethoprim-sulfamethoxazole (TMP-SMX) for prophylaxis of PJP after kidney transplantation.
Adult renal transplant recipients (RTRs) who were transplanted between January 1, 2015 and July 1, 2018 were evaluated. A total of 189 RTRs were prescribed PJP prophylactic regimen during the study period (TWDS group: n=98; DSS group: n=91).
Morbidity due to PJP infection was significantly higher in TWDS group as compared with DSS group (8.60% vs 1.14%, p= 0.021). There was a significant trend toward higher prevalence of confirmed PJP (log-rank=0.021) in TWDS group. The use of DDS TMP-SMX for prophylaxis after kidney transplantation was associated with a 79% reduction in the incidence of PJP comparing the prophylactic regimen of TWDS. There was no significant difference between the two groups in the overall rate of premature TMP-SMX discontinuation and laboratory indexes.
Six months of DSS TMP-SMX prophylaxis was more effective than TWDS TMP-SMX regimen with the same safety profile.
对于临床医生来说，选择最佳的卡氏肺孢子虫肺炎（PJP）预防方案具有一定难度。本研究旨在评估每周三次双倍剂量（TWDS）与每日单次剂量（DSS）复方磺胺甲噁唑（TMP-SMX）预防肾移植后 PJP 的有效性和安全性。
本研究纳入了 2015 年 1 月 1 日至 2018 年 7 月 1 日期间接受肾移植的成年患者。在研究期间，共有 189 例肾移植受者（RTR）接受了 PJP 预防方案治疗（TWDS 组：n=98；DSS 组：n=91）。
与 DSS 组相比，TWDS 组 PJP 感染的发病率明显更高（8.60% vs 1.14%，p=0.021）。TWDS 组确诊 PJP 的发生率存在显著升高趋势（对数秩检验=0.021）。与 TWDS 方案相比，肾移植后使用 DDS TMP-SMX 进行预防可使 PJP 的发生率降低 79%。两组在 TMP-SMX 预防性停药的总发生率和实验室指标方面无显著差异。
与 TWDS 方案相比，DSS TMP-SMX 方案预防 6 个月可更有效预防 PJP，且安全性相当。
