The use of intravenous pentamidine for the prophylaxis of Pneumocystis pneumonia in pediatric patients

Abstract

Pneumocystis jiroveci pneumonia was common in the immunocompromised host before the widespread use of prophylaxis. When trimethoprim-sulfamethoxazole is not tolerated, prophylaxis with intravenous pentamidine (IVP) may be initiated. We performed a retrospective analysis of all pediatric patients who received IVP regarding efficacy, safety, and reason for initiation. Of 106 patients included in our analysis, one patient tested positive for Pneumocystis DNA. Adverse events were reported in 18% of IVP courses, and main reason for initiation was cytopenia (59%). We found IVP to be effective and safe, and recommend the use of IVP in pediatric patients in whom first-line prophylaxis is contraindicated.

Pentamidine for Prophylaxis against Pneumocystis jirovecii Pneumonia in Pediatric Oncology Patients Receiving Immunosuppressive Chemotherapy

“…Recent studies have reported acceptable breakthrough PCP rates (0% to 1.3%) with the use of i.v. pentamidine for PCP prophylaxis in immunocompromised children receiving chemotherapy or status post hematopoietic stem cell transplant (HSCT) or solid organ transplant (SOT) (10,14,15).…”

Intravenous pentamidine for Pneumocystis pneumonia prophylaxis in children undergoing autologous hematopoietic stem cell transplant

“…We are writing you with regards to the brief report, “The use of intravenous pentamidine for the prophylaxis of Pneumocystis pneumonia in pediatric patients,” published in January 2017 …”

“…While TMP–SMX remains the gold standard for PJP prophylaxis, bone marrow toxicity is a limiting factor for its use in pediatric patients receiving tandem ASCT, who require adequate hematologic recovery between them. American and European guidelines suggest second‐line drugs such as inhaled pentamidine, dapsone, or atovaquone, with limited evidence . Some practicalities should be considered, related to equipment and facilities that may make using inhaled pentamidine difficult …”

“…

We are writing you with regards to the brief report, "The use of intravenous pentamidine for the prophylaxis of Pneumocystis pneumonia in pediatric patients," published in January 2017. 1 We would like to share our positive experience with intravenous pentamidine (IVP) in prophylaxis of Pneumocystis jirovecii pneumonia (PJP) in pediatric patients undergoing autologous stem cell transplantation (ASCT) during the period of pancytopenia prior to engraftment.Our hospital is a pediatric referral center for childhood cancer. IVP prophylaxis for PJP in ASCT patients has been used since 2007.

…”

“…American and European guidelines suggest secondline drugs such as inhaled pentamidine, dapsone, or atovaquone, with Abbreviations: ASCT, autologous stem cell transplant; IVP, intravenous pentamidine; PJP, Pneumocystis jirovecii pneumonia; TMP-SMX, trimethoprim-sulfamethoxazole limited evidence. 1,6,7 Some practicalities should be considered, related to equipment and facilities that may make using inhaled pentamidine difficult. 2,6 Our series of ACST pediatric patients treated with IVP is homogeneous in indication and dosage regimen.…”