A Systematic Review of Two Different Trimetoprim-Sulfamethoxazole Regimens Used to Prevent Pneumocystis jirovecii and No Prophylaxis at All in Transplant Recipients: Appraising the Evidence

P. Di Cocco, G. Orlando, L. Bonanni, M. D'Angelo, K. Clemente, S. Greco, G. Gravante, F. Madeddu, C. Scelzo, A. Famulari, F. Pisani

Research output: Contribution to journalArticle

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Abstract

Background: The aim of this study was to clarify the potential advantages of a low-dose regimen of trimethoprim-sulfamethoxazole prophylaxis to prevent Pneumocystis jirovecii pneumonia (PJP) in transplant recipients (80/400 mg/d every day or 160/800 mg/d every other day) with those obtained from the full-dose prophylaxis (160/800 mg/d every day) or no prophylaxis. Methods: Prospectively randomized and retrospectively case controlled studies were selected. Results: Four studies matched the inclusion criteria-2 randomized and 2 case controls-for a total of 570 patients. The pneumonia incidence was 0% after full-dose prophylaxis (0/181), 1% after the low-dose regimen (1/105), and 11% with no prophylaxis (31/284). Pneumonia occurrences were significant lower between the full-dose prophylaxis versus the no prophylaxis group (0% vs 11%; P <.001), and between the low-dose and no prophylaxis groups (1% vs 11%; P <.001). There was no difference between patients receiving the full-dose prophylaxis versus the low-dose regimen (0% vs 1%; P = NS). Conclusions: The low-dose gives similar results as the full-dose regimen for the prevention of PJP and seems a feasible, safe option for transplanted patients.

Original languageEnglish
Pages (from-to)1201-1203
Number of pages3
JournalTransplantation Proceedings
Volume41
Issue number4
DOIs
Publication statusPublished - May 2009

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Sulfamethoxazole
Pneumocystis carinii
Pneumocystis Pneumonia
Pneumonia
Sulfamethoxazole Drug Combination Trimethoprim
Incidence
Transplant Recipients

ASJC Scopus subject areas

  • Surgery
  • Transplantation
  • Medicine(all)

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A Systematic Review of Two Different Trimetoprim-Sulfamethoxazole Regimens Used to Prevent Pneumocystis jirovecii and No Prophylaxis at All in Transplant Recipients : Appraising the Evidence. / Di Cocco, P.; Orlando, G.; Bonanni, L.; D'Angelo, M.; Clemente, K.; Greco, S.; Gravante, G.; Madeddu, F.; Scelzo, C.; Famulari, A.; Pisani, F.

In: Transplantation Proceedings, Vol. 41, No. 4, 05.2009, p. 1201-1203.

Research output: Contribution to journalArticle

Di Cocco, P. ; Orlando, G. ; Bonanni, L. ; D'Angelo, M. ; Clemente, K. ; Greco, S. ; Gravante, G. ; Madeddu, F. ; Scelzo, C. ; Famulari, A. ; Pisani, F. / A Systematic Review of Two Different Trimetoprim-Sulfamethoxazole Regimens Used to Prevent Pneumocystis jirovecii and No Prophylaxis at All in Transplant Recipients : Appraising the Evidence. In: Transplantation Proceedings. 2009 ; Vol. 41, No. 4. pp. 1201-1203.
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abstract = "Background: The aim of this study was to clarify the potential advantages of a low-dose regimen of trimethoprim-sulfamethoxazole prophylaxis to prevent Pneumocystis jirovecii pneumonia (PJP) in transplant recipients (80/400 mg/d every day or 160/800 mg/d every other day) with those obtained from the full-dose prophylaxis (160/800 mg/d every day) or no prophylaxis. Methods: Prospectively randomized and retrospectively case controlled studies were selected. Results: Four studies matched the inclusion criteria-2 randomized and 2 case controls-for a total of 570 patients. The pneumonia incidence was 0{\%} after full-dose prophylaxis (0/181), 1{\%} after the low-dose regimen (1/105), and 11{\%} with no prophylaxis (31/284). Pneumonia occurrences were significant lower between the full-dose prophylaxis versus the no prophylaxis group (0{\%} vs 11{\%}; P <.001), and between the low-dose and no prophylaxis groups (1{\%} vs 11{\%}; P <.001). There was no difference between patients receiving the full-dose prophylaxis versus the low-dose regimen (0{\%} vs 1{\%}; P = NS). Conclusions: The low-dose gives similar results as the full-dose regimen for the prevention of PJP and seems a feasible, safe option for transplanted patients.",
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