Efficacies of atovaquone, pentamidine, and trimethoprim/sulfamethoxazole for the prevention of Pneumocystis jirovecii pneumonia in patients with connective tissue diseases
Efficacies of atovaquone, pentamidine, and trimethoprim/sulfamethoxazole for the prevention of Pneumocystis jirovecii pneumonia in patients with connective tissue diseases
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DOI：
10.1016/j.jiac.2019.01.005
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发表时间：
2019-05-01
影响因子：
2.2
通讯作者：
Ota, Yasuo
中科院分区：
文献类型：
--
作者：
Kitazawa, Takatoshi;Seo, Kazunori;Ota, Yasuo
背景：耶氏肺孢子虫肺炎（PCP）是一种机会性感染的患者类固醇治疗结缔组织疾病。五氯苯酚初级预防的标准药物是甲氧苄啶/磺胺甲恶唑（TMP-SMX），尽管这种药物可引起常见的不良反应，包括骨髓抑制和肾毒性，导致停止使用。喷他脒气雾剂和口服阿托伐醌是预防五氯苯酚的替代品。阿托伐醌，喷他脒，TMP-SMX，以防止PCP在结缔组织疾病患者的疗效从来没有比较：结缔组织疾病开始类固醇治疗和PCP预防住院患者参加。五氯苯酚预防方案为口服TMP-SMX、喷他脒雾化吸入或口服阿托伐醌。信息是回顾性收集的实验室检查结果，PCP预防的持续时间，并终止PCP prophylaxis.Results的原因的医疗记录：96例患者接受PCP预防。所有这些患者最初都用TMP-SMX治疗，但在研究期间，33例患者用喷他脒代替，7例患者用阿托伐醌代替。41例（43%）患者因不良事件停用TMP-SMX，5例（15%）患者也停用喷他脒。没有患者停用阿托伐醌。TMP-SMX和喷他脒停药的最常见原因是血细胞减少（N = 15）和哮喘（N = 2）。在开始PCP预防后一年，继续使用TMP-SMX、喷他脒和阿托伐醌治疗的比率分别为55.3%、68.6%和100%（P = 0.01）。结论：虽然TMP-SMX的PCP预防不得不停止在43%的结缔组织疾病患者，喷他脒和阿托伐醌耐受性良好。(c)2019年日本化疗学会和日本传染病协会。由爱思唯尔有限公司出版。保留所有权利。
Background: Pneumocystis jirovecii pneumonia (PCP) is an opportunistic infection in patients on steroid therapy for connective tissue diseases. The standard agent for primary PCP prophylaxis is trimethoprim/sulfamethoxazole (TMP-SMX), although this agent can cause common adverse reactions, including myelosuppression and renal toxicity, that result in cessation. Aerosolized pentamidine and oral atovaquone are alternatives for PCP prophylaxis. The efficacies of atovaquone, pentamidine, and TMP-SMX to prevent PCP in patients with connective tissue diseases have never been compared.Methods: Hospitalized patients with connective tissue diseases who started steroid therapy and PCP prophylaxis were enrolled. PCP prophylaxis regimens were oral TMP-SMX, aerosolized pentamidine, or oral atovaquone. Information was retrospectively collected from medical records about laboratory findings, duration of PCP prophylaxis, and reasons for terminating PCP prophylaxis.Results: Ninety-six patients received PCP prophylaxis. All of them were initially treated with TMP-SMX, but this was replaced during the study period with pentamidine in 33 patients and with atovaquone in 7. Forty-one (43%) patients discontinued TMP-SMX because of adverse events, and 5 (15%) also discontinued pentamidine. None of the patients discontinued atovaquone. The most frequent causes of TMP-SMX and pentamidine cessation were cytopenia (N = 15) and asthma (N = 2). The rates of continuing treatment with TMP-SMX, pentamidine, and atovaquone at one year after starting PCP prophylaxis were 55.3%, 68.6%, and 100%, respectively (P = 0.01). None of the patients developed PCP.Conclusion: Although TMP-SMX for PCP prophylaxis had to be discontinued in 43% of patients with connective tissue diseases, pentamidine and atovaquone were well tolerated. (c) 2019 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.