Effectiveness and safety evaluation of thrice weekly double strength vs daily single strength trimethoprim-sulfamethoxazole for prophylaxis of pneumocystis jirovecii pneumonia after kidney transplantation: a two year prospective cohort study

Abstract

Purpose: It is hard for clinicians to choose the best regimen for pneumocystis jirovecii pneumonia (PJP) prophylaxis. The aim is to evaluate the effectiveness and safety of thrice weekly double strength (TWDS) vs daily single strength (DSS) trimethoprim-sulfamethoxazole (TMP-SMX) for prophylaxis of PJP after kidney transplantation. Methods: Adult renal transplant recipients (RTRs) who were transplanted between January 1, 2015 and July 1, 2018 were evaluated. A total of 189 RTRs were prescribed PJP prophylactic regimen during the study period (TWDS group: n=98; DSS group: n=91). Results: Morbidity due to PJP infection was significantly higher in TWDS group as compared with DSS group (8.60% vs 1.14%, p= 0.021). There was a significant trend toward higher prevalence of confirmed PJP (log‐rank=0.021) in TWDS group. The use of DDS TMP-SMX for prophylaxis after kidney transplantation was associated with a 79% reduction in the incidence of PJP comparing the prophylactic regimen of TWDS. There was no significant difference between the two groups in the overall rate of premature TMP-SMX discontinuation and laboratory indexes. Conclusion: Six months of DSS TMP-SMX prophylaxis was more effective than TWDS TMP-SMX regimen with the same safety profile.

Clinical Characteristics and Epidemiological Analysis of Pneumocystis Jirovecii Pneumonia Infection in Kidney Transplant Patients with Trimethoprim-Sulfamethoxazole Dose Reduction Prophylaxis Strategy

“…Studies have confirmed that six months of daily single-strength TMP-SMX prophylaxis was more efficacious than thrice weekly double-strength TMP-SMX. 7 Meanwhile, in patients prescribed daily single-strength TMP-SMX, dose reductions were commonly observed, with nearly 50% of patients having their dosing regimen adjusted to single-strength, thrice weekly. 8 We investigated seven hospitals in China and found that the prevention strategies of each hospital were different.…”