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Treatment With Reduced-Dose Trimethoprim-Sulfamethoxazole Is Effective in Mild to Moderate Pneumocystis jirovecii Pneumonia in Patients With Hematologic Malignancies

Hammarström, Helena ; Krifors, Anders ; Athlin, Simon ; Friman, Vanda ; Golestani, Karan LU ; Hällgren, Anita ; Otto, Gisela LU ; Oweling, Sara ; Pauksens, Karlis and Kinch, Amelie , et al. (2023) In Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 76(3). p.1252-1260
Abstract

BACKGROUND: Recent studies have reported that reduced-dose trimethoprim-sulfamethoxazole (TMP-SMX) may be effective in the treatment of Pneumocystis jirovecii pneumonia (PJP), but data are lacking for patients with hematologic malignancies.

METHODS: This retrospective study included all adult hematologic patients with PJP between 2013 and 2017 at 6 Swedish university hospitals. Treatment with 7.5-15 mg TMP/kg/day (reduced dose) was compared with >15-20 mg TMP/kg/day (standard dose), after correction for renal function. The primary outcome was the change in respiratory function (Δpartial pressure of oxygen [PaO2]/fraction of inspired oxygen [FiO2]) between baseline and day 8. Secondary outcomes were clinical failure and/or death... (More)

BACKGROUND: Recent studies have reported that reduced-dose trimethoprim-sulfamethoxazole (TMP-SMX) may be effective in the treatment of Pneumocystis jirovecii pneumonia (PJP), but data are lacking for patients with hematologic malignancies.

METHODS: This retrospective study included all adult hematologic patients with PJP between 2013 and 2017 at 6 Swedish university hospitals. Treatment with 7.5-15 mg TMP/kg/day (reduced dose) was compared with >15-20 mg TMP/kg/day (standard dose), after correction for renal function. The primary outcome was the change in respiratory function (Δpartial pressure of oxygen [PaO2]/fraction of inspired oxygen [FiO2]) between baseline and day 8. Secondary outcomes were clinical failure and/or death at day 8 and death at day 30.

RESULTS: Of a total of 113 included patients, 80 patients received reduced dose and 33 patients received standard dose. The overall 30-day mortality in the whole cohort was 14%. There were no clinically relevant differences in ΔPaO2/FiO2 at day 8 between the treatment groups, either before or after controlling for potential confounders in an adjusted regression model (-13.6 mm Hg [95% confidence interval {CI}, -56.7 to 29.5 mm Hg] and -9.4 mm Hg [95% CI, -50.5 to 31.7 mm Hg], respectively). Clinical failure and/or death at day 8 and 30-day mortality did not differ significantly between the groups (18% vs 21% and 14% vs 15%, respectively). Among patients with mild to moderate pneumonia, defined as PaO2/FiO2 >200 mm Hg, all 44 patients receiving the reduced dose were alive at day 30.

CONCLUSIONS: In this cohort of 113 patients with hematologic malignancies, reduced-dose TMP-SMX was effective and safe for treating mild to moderate PJP.

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publishing date
type
Contribution to journal
publication status
published
keywords
Adult, Humans, Pneumonia, Pneumocystis/drug therapy, Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use, Retrospective Studies, Pneumocystis carinii, Hematologic Neoplasms/complications
in
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
volume
76
issue
3
pages
1252 - 1260
publisher
Oxford University Press
external identifiers
  • scopus:85147783441
  • pmid:35594562
ISSN
1537-6591
DOI
10.1093/cid/ciac386
language
English
LU publication?
no
additional info
© The Author(s) 2022. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.
id
555e8d23-3fa0-492e-8b18-13bd54ebe227
date added to LUP
2024-09-12 10:18:26
date last changed
2025-05-10 02:35:52
@article{555e8d23-3fa0-492e-8b18-13bd54ebe227,
  abstract     = {{<p>BACKGROUND: Recent studies have reported that reduced-dose trimethoprim-sulfamethoxazole (TMP-SMX) may be effective in the treatment of Pneumocystis jirovecii pneumonia (PJP), but data are lacking for patients with hematologic malignancies.</p><p>METHODS: This retrospective study included all adult hematologic patients with PJP between 2013 and 2017 at 6 Swedish university hospitals. Treatment with 7.5-15 mg TMP/kg/day (reduced dose) was compared with &gt;15-20 mg TMP/kg/day (standard dose), after correction for renal function. The primary outcome was the change in respiratory function (Δpartial pressure of oxygen [PaO2]/fraction of inspired oxygen [FiO2]) between baseline and day 8. Secondary outcomes were clinical failure and/or death at day 8 and death at day 30.</p><p>RESULTS: Of a total of 113 included patients, 80 patients received reduced dose and 33 patients received standard dose. The overall 30-day mortality in the whole cohort was 14%. There were no clinically relevant differences in ΔPaO2/FiO2 at day 8 between the treatment groups, either before or after controlling for potential confounders in an adjusted regression model (-13.6 mm Hg [95% confidence interval {CI}, -56.7 to 29.5 mm Hg] and -9.4 mm Hg [95% CI, -50.5 to 31.7 mm Hg], respectively). Clinical failure and/or death at day 8 and 30-day mortality did not differ significantly between the groups (18% vs 21% and 14% vs 15%, respectively). Among patients with mild to moderate pneumonia, defined as PaO2/FiO2 &gt;200 mm Hg, all 44 patients receiving the reduced dose were alive at day 30.</p><p>CONCLUSIONS: In this cohort of 113 patients with hematologic malignancies, reduced-dose TMP-SMX was effective and safe for treating mild to moderate PJP.</p>}},
  author       = {{Hammarström, Helena and Krifors, Anders and Athlin, Simon and Friman, Vanda and Golestani, Karan and Hällgren, Anita and Otto, Gisela and Oweling, Sara and Pauksens, Karlis and Kinch, Amelie and Blennow, Ola}},
  issn         = {{1537-6591}},
  keywords     = {{Adult; Humans; Pneumonia, Pneumocystis/drug therapy; Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use; Retrospective Studies; Pneumocystis carinii; Hematologic Neoplasms/complications}},
  language     = {{eng}},
  month        = {{02}},
  number       = {{3}},
  pages        = {{1252--1260}},
  publisher    = {{Oxford University Press}},
  series       = {{Clinical infectious diseases : an official publication of the Infectious Diseases Society of America}},
  title        = {{Treatment With Reduced-Dose Trimethoprim-Sulfamethoxazole Is Effective in Mild to Moderate Pneumocystis jirovecii Pneumonia in Patients With Hematologic Malignancies}},
  url          = {{http://dx.doi.org/10.1093/cid/ciac386}},
  doi          = {{10.1093/cid/ciac386}},
  volume       = {{76}},
  year         = {{2023}},
}