Format

Send to

Choose Destination
J Pediatr. 2014 Feb;164(2):389-92.e1. doi: 10.1016/j.jpeds.2013.10.021. Epub 2013 Nov 16.

Single-day trimethoprim/sulfamethoxazole prophylaxis for Pneumocystis pneumonia in children with cancer.

Author information

1
Department of Pediatric Hematology-Oncology, Azienda Ospedaliero Universitaria Meyer Children Hospital, Florence, Italy.
2
Pediatric Hematology-Oncology, Padua, Italy.
3
Pediatric Oncology and Hematology, Lalla Seràgnoli Unit, University of Bologna, Bologna, Italy.
4
Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Turin, Italy.
5
Pediatric Hematology-Oncology, Monza, Italy.
6
Pediatric Hematology-Oncology, Bari, Italy.
7
Pediatric Hematology-Oncology, ARNAS Civico, Palermo, Italy.
8
Pediatric Hematology-Oncology, Catania, Italy.
9
Division of Pediatric Hematology/Oncology, G Salesi Women's and Children's Hospital, Ancona, Italy.
10
Pediatric Hematology-Oncology, BMT Unit, Spedali Civili, Brescia, Italy.
11
Pediatric Hematology-Oncology, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
12
Pediatric Hematology-Oncology, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.
13
Pediatric and Hematology-Oncology, University Hospital Azienda Ospedaliero Universitaria di Parma, Parma, Italy.
14
Pediatric Hematology-Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
15
Pediatric Hematology-Oncology, University Hospital, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy.
16
Pediatric Hematology-Oncology, Cagliari, Italy.
17
Pediatric Oncology/Hematology, BMT Unit, Section of Hematology, Department of Internal and Experimental Medicine, University of Perugia, Perugia, Italy.
18
Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionaledei Tumori, Milan, Italy.
19
Pediatric Immunology, San Raffaele Telethon Institute for Gene Therapy, Milan, Italy.
20
Epidemiology, Azienda Ospedaliero Universitaria Meyer Children Hospital, Florence, Italy.
21
Infectious Disease Unit, Gaslini Institute, Istituto Giannina Gaslini, Genoa, Italy.
22
Department of Pediatric Hematology-Oncology, Azienda Ospedaliero Universitaria Meyer Children Hospital, Florence, Italy. Electronic address: maurizio.arico@ittumori.it.

Abstract

OBJECTIVE:

To determine whether a simplified, 1-day/week regimen of trimethoprim/sulfamethoxazole is sufficient to prevent Pneumocystis (jirovecii [carinii]) pneumonia (PCP). Current recommended regimens for prophylaxis against PCP range from daily administration to 3 consecutive days per week dosing.

STUDY DESIGN:

A prospective survey of the regimens adopted for the PCP prophylaxis in all patients treated for childhood cancer at pediatric hematology-oncology centers of the Associazione Italiana Ematologia Oncologia Pediatrica.

RESULTS:

The 20 centers participating in the study reported a total of 2466 patients, including 1093 with solid tumor and 1373 with leukemia/lymphoma (or primary immunodeficiency; n = 2). Of these patients, 1371 (55.6%) received the 3-day/week prophylaxis regimen, 406 (16.5%) received the 2-day/week regimen, and 689 (27.9%), including 439 with leukemia/lymphoma, received the 1-day/week regimen. Overall, only 2 cases of PCP (0.08%) were reported, both in the 2-day/week group. By intention to treat, the cumulative incidence of PCP at 3 years was 0.09% overall (95% CI, 0.00-0.40%) and 0.51% for the 2-day/week group (95% CI, 0.10%-2.00%). Remarkably, both patients who failed had withdrawn from prophylaxis.

CONCLUSION:

A single-day course of prophylaxis with trimethoprim/sulfamethoxazole may be sufficient to prevent PCP in children with cancer undergoing intensive chemotherapy regimens. This simplified strategy might have implications for the emerging need for PCP prophylaxis in other patients subjected to the increased use of biological and nonbiological agents that induce higher levels of immune suppression, such as those with rheumatic diseases.

KEYWORDS:

AIEOP; Associazione Italiana Ematologia Oncologia Pediatrica; PCP; Pneumocystis (jirovecii [carinii]) pneumonia; SMX; Sulfamethoxazole; TMP; Trimethoprim

PMID:
24252793
DOI:
10.1016/j.jpeds.2013.10.021
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center