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

Désirée Caselli, Maria Grazia Petris, Roberto Rondelli, Francesca Carraro, Antonella Colombini, Paola Muggeo, Ottavio Ziino, Fraia Melchionda, Giovanna Russo, Paolo Pierani, Elena Soncini, Raffaella Desantis, Giulio Zanazzo, Angelica Barone, Simone Cesaro, Monica Cellini, Rossella Mura, Giuseppe M. Milano, Cristina Meazza, Maria P. CicaleseSerena Tropia, Salvatore De Masi, Elio Castagnola, Maurizio Aricò

Research output: Contribution to journalArticlepeer-review

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 Remarkably, both patients who failed had withdrawn from prophylaxis.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.

Original languageEnglish
JournalJournal of Pediatrics
Volume164
Issue number2
DOIs
Publication statusPublished - Feb 2014

Keywords

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

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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