BACKGROUND: Trimethoprim/sulfamethoxazole (TMP/SMX) is considered first-line therapy for pneumocystis jiroveci pneumonia (PCP) in renal transplant patients. Alternatives have not been formally studied. Clindamycin-primaquine (C-P) is effective in HIV-associated PCP, but data in renal transplant patients are lacking. PATIENTS AND METHODS: Retrospective cohort study of 57 consecutive renal transplant patients who developed PCP and were treated with C-P (n = 23) or TMP/SMX (n = 34). RESULTS: A non-significantly higher failure rate was observed in patients on C-P due to lack of efficacy (30.4 versus 20.6%, p = 0.545). The difference was more pronounced in severe PCP (60 versus 37.5%, p = 0.611) and a significantly lower efficacy of C-P was seen when used as salvage therapy. The two patients who had received C-P after not responding to TMP/SMX failed this regimen, but all seven patients who had failed initial treatment with C-P and had been switched to TMP/SMX were cured (p = 0.028). No treatment-limiting adverse reactions were reported for patients on C-P while six patients (17.6%) on TMP/SMX developed possibly related treatment-limiting toxicity (p = 0.071). However, in only two patients adverse events were definitely related to TMP/SMX (5.9%). CONCLUSIONS: Clindamycin-primaquine appears to be safe and well tolerated for treating PCP in renal transplant patients but is probably less effective than TMP/SMX, the standard regimen. However, our data indicates that C-P represents an acceptable alternative for patients with contraindications or treatment emergent toxicities during TMP/SMX use. Notably, TMP/SMX was also acceptably tolerated in most patients. TMP/SMX remains an effective salvage regimen in case of C-P failure.
BACKGROUND:Trimethoprim/sulfamethoxazole (TMP/SMX) is considered first-line therapy for pneumocystis jiroveci pneumonia (PCP) in renal transplant patients. Alternatives have not been formally studied. Clindamycin-primaquine (C-P) is effective in HIV-associated PCP, but data in renal transplant patients are lacking. PATIENTS AND METHODS: Retrospective cohort study of 57 consecutive renal transplant patients who developed PCP and were treated with C-P (n = 23) or TMP/SMX (n = 34). RESULTS: A non-significantly higher failure rate was observed in patients on C-P due to lack of efficacy (30.4 versus 20.6%, p = 0.545). The difference was more pronounced in severe PCP (60 versus 37.5%, p = 0.611) and a significantly lower efficacy of C-P was seen when used as salvage therapy. The two patients who had received C-P after not responding to TMP/SMX failed this regimen, but all seven patients who had failed initial treatment with C-P and had been switched to TMP/SMX were cured (p = 0.028). No treatment-limiting adverse reactions were reported for patients on C-P while six patients (17.6%) on TMP/SMX developed possibly related treatment-limiting toxicity (p = 0.071). However, in only two patients adverse events were definitely related to TMP/SMX (5.9%). CONCLUSIONS:Clindamycin-primaquine appears to be safe and well tolerated for treating PCP in renal transplant patients but is probably less effective than TMP/SMX, the standard regimen. However, our data indicates that C-P represents an acceptable alternative for patients with contraindications or treatment emergent toxicities during TMP/SMX use. Notably, TMP/SMX was also acceptably tolerated in most patients. TMP/SMX remains an effective salvage regimen in case of C-P failure.
Authors: Bertram L Kasiske; Martin G Zeier; Jeremy R Chapman; Jonathan C Craig; Henrik Ekberg; Catherine A Garvey; Michael D Green; Vivekanand Jha; Michelle A Josephson; Bryce A Kiberd; Henri A Kreis; Ruth A McDonald; John M Newmann; Gregorio T Obrador; Flavio G Vincenti; Michael Cheung; Amy Earley; Gowri Raman; Samuel Abariga; Martin Wagner; Ethan M Balk Journal: Kidney Int Date: 2009-10-21 Impact factor: 10.612
Authors: Traci Nicole Fraser; Andres A Avellaneda; Edward A Graviss; Daniel M Musher Journal: J Antimicrob Chemother Date: 2012-02-20 Impact factor: 5.790
Authors: J Thoden; A Potthoff; J R Bogner; N H Brockmeyer; S Esser; K Grabmeier-Pfistershammer; B Haas; K Hahn; G Härter; M Hartmann; C Herzmann; J Hutterer; A R Jordan; C Lange; S Mauss; D Meyer-Olson; F Mosthaf; M Oette; S Reuter; A Rieger; T Rosenkranz; M Ruhnke; B Schaaf; S Schwarze; H J Stellbrink; H Stocker; A Stoehr; M Stoll; C Träder; M Vogel; D Wagner; C Wyen; C Hoffmann Journal: Infection Date: 2013-09-14 Impact factor: 3.553
Authors: Isabelle Suárez; Lisa Roderus; Edeltraud van Gumpel; Norma Jung; Clara Lehmann; Gerd Fätkenheuer; Pia Hartmann; Georg Plum; Jan Rybniker Journal: Infection Date: 2017-03-16 Impact factor: 3.553