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Int J Antimicrob Agents. 2019 Oct 14. pii: S0924-8579(19)30275-4. doi: 10.1016/j.ijantimicag.2019.10.001. [Epub ahead of print]

Anidulafungin as an alternative treatment for Pneumocystis jirovecii pneumonia in patients who could not tolerate Trimethoprim/sulfamethoxazole.

Author information

1
Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
2
Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan;. Electronic address: jychien@ntu.edu.tw.
3
Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan;; Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: hsporen@ntu.edu.tw.

Abstract

Evidence supporting the use of echinocandins alone as alternative agents for the treatment of Pneumocystis jirovecii pneumonia (PCP) is limited and controversial. This retrospective cohort study was conducted at the National Taiwan University Hospital from July 1, 2015 to December 31, 2017. Using multivariable Cox's regression analyses, we investigated the outcomes of patients receiving trimethoprim-sulfamethoxazole (TMP-SMZ) or anidulafungin single therapy as an alternative treatment for PCP. A total of 207 patients were screened and 170 patients were enrolled. Among them, 134 (79%) patients received TMP-SMZ and 36 (21%) patients received anidulafungin as alternative anti-PCP treatment. The overall 60-day mortality was 34% (58/170), comprising 39% (14/36) in the anidulafungin group and 33% (44/134; P = 0.55) in the TMP-SMZ group. Age >60 years (hazard ratio (HR), 1.840; 95% confidence interval (CI), 1.039- 3.259; P = 0.036) and human immunodeficiency virus (HIV) infection (HR, 0.102; 95% CI, 0.013- 0.771; P = 0.027) independently predicted 60-day mortality. Patients with lower SpO2/FiO2 ratio (HR, 0.994; 95% CI, 0.990- 0.998; P = 0.005) showed higher 60-day mortality. In a Kaplan-Meier survival analysis, anidulafungin as alternative anti-PCP treatment was not correlated with higher mortality rates (P = 0.605). Using TMP-SMZ or anidulafungin as alternative anti-PCP treatment had similar 60-day mortality. Our findings suggest that anidulafungin therapy may be an effective and alternative treatment for PCP in patients who cannot tolerate TMP-SMZ.

KEYWORDS:

Echinocandin; Outcomes; Pneumocystis jirovecii pneumonia; Trimethoprim-sulfamethoxazole

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