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Dapsone-induced methemoglobinemia in pediatric oncology patients: case examples
1Nursing Education, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
Abstract:
Over the last 25 years, significant advances have been made in supportive care of the immunocompromised patient. One significant advance is the use of trimethoprim-sulfamethoxazole (TMP-SMZ) in the prevention of Pneumocystic carinii pneumonia (PCP). Although TMP-SMZ remains the drug of choice for PCP prophylaxis, children who develop or have a history of adverse reactions must be prescribed an alternative treatment. In these instances, medications such as dapsone, aerosolized pentamidine, or atovaquone are prescribed. This report discusses four children with sulfa allergy who were prescribed dapsone and later developed methemoglobinemia. Although methemoglobinemia is associated with dapsone, there was no reference found regarding this link in the pediatric oncology literature. The purpose of these clinical examples is to alert the pediatric nurse and advanced practitioner to the association of dapsone and methemoglobinemia.
Insights
Trimethoprim-sulfamethoxazole (TMP-SMZ) is key for preventing Pneumocystic carinii pneumonia (PCP) in immunocompromised children. However, alternative drugs like dapsone can cause methemoglobinemia, a risk particularly for those with sulfa allergies.
Area of Science:
- Pediatric Oncology
- Pharmacology
- Infectious Disease Prevention
Background:
- Advances in supportive care have improved outcomes for immunocompromised patients.
- Trimethoprim-sulfamethoxazole (TMP-SMZ) is the standard for Pneumocystic carinii pneumonia (PCP) prophylaxis.
- Alternative agents are necessary for patients with TMP-SMZ intolerance or allergy.
Observation:
- Four pediatric patients with sulfa allergy were treated with dapsone for PCP prophylaxis.
- These patients subsequently developed methemoglobinemia.
- This adverse event was not previously documented in pediatric oncology literature regarding dapsone.
Findings:
- Dapsone is a potential alternative for PCP prophylaxis in sulfa-allergic children.
- Methemoglobinemia is a significant adverse effect associated with dapsone use.
- The link between dapsone and methemoglobinemia may be underreported in pediatric oncology.
Implications:
- Pediatric nurses and advanced practitioners should be aware of the risk of methemoglobinemia with dapsone.
- Careful monitoring for methemoglobinemia is crucial in pediatric patients receiving dapsone.
- This highlights the need for vigilance regarding drug-induced adverse events in immunocompromised children.
