Prophylaxis of Pneumocystis Pneumonia in Immunocompromised Non-HIV-Infected Patients: Systematic Review and Meta-analysis of Randomized Controlled Trials

Should rheumatoid factor in rheumatoid arthritis be sent to Davy Jones’s Locker?

“…In haematological malignancies, a meta-analysis of randomized controlled trials identified patients with acute lymphoblastic leukaemia and allogeneic bone marrow transplant at increased risk for PCP and in need for prophylaxis [6]. Recent clinical observations suggest this association with PCP is related to RTX based treatment regimens [3].…”

“…In transplantation medicine, renal transplant recipients have an increased risk for PCP in the early posttransplant period justifying the use of prophylaxis in the first 6-12 months after transplantation [6,27]. However 2 cases of late onset PCP have also been described in where B cells counts at the time of PCP diagnosis were still low -respectively 0.01 and 0.05 x10^9/L -nearly 3 years after the administration of a single dose of RTX (500 mg) for humoral rejection [28].…”

“…Treatment with methotrexate [4], high-dose prednisolone [4] and cyclophosphamide [5] in association with lymphopenia increases the risk for PCP in GPA patients. While prophylaxis with trimethoprim-sulphamethoxazole (TMP-SMX) is effective [5,6], there are few formal recommendations. The use of PCP prophylaxis is recommended with prolonged daily systemic corticosteroid therapy -≥20 mg of prednisolone daily for ≥ 1 month [2,7], while EULAR encourages its use during Cyclophosphamide therapy in AAV [8].…”

Infecciones en pacientes reumatológicos asociadas a corticosteroides y antagonistas del factor de necrosis tumoral α

“…No existen estudios controlados que directamente hayan evaluado la eficacia de la profilaxis de neumonía por P. jiroveci en usuarios de corticosteroides. La eficacia de un esquema diario con cotrimoxazol es muy alta en pacientes oncohematológicos y en pacientes con trasplante de órganos sólidos (> 90% eficacia) y además reduce el riesgo de mortalidad por esta causa (eficacia > 80%) 102 . Las dosis en los esquemas ha sido variable con una tendencia central a usar una tableta de cotrimoxazol forte (800/160 mg de sulfametoxazol/trimetoprim) al día.…”

Prevention of Infection in Lupus Patients

“…Previous studies indicate that a dose of glucocorticoids 16 mg increases the risk of PCP in non-HIV individuals and reported a PCP prevalence of 0.16% in SLE patients on cyclophosphamide [11,42]. Because of the risk of serious adverse events associated with antimicrobial prophylaxis for PCP, it is recommended that prophylaxis only be used when the risk of PCP in SLE patients with CD4+ Tcell count <250/μl, interstitial pulmonary fibrosis, high SLEDAI, severe nephritis, or with chronic use of prednisone ≥ 20 mg/day [43,44] …”