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Intravenous pentamidine is effective as second line Pneumocystis pneumonia prophylaxis in pediatric oncology patients

Su Young Kim1, Alix A Dabb, Donald J Glenn

  • 1Division of Pediatric Oncology, Department of Oncology, The Johns Hopkins Hospital, Baltimore, Maryland, USA.

Pediatric Blood & Cancer
|July 20, 2007
PubMed

Insights

Intravenous pentamidine is an effective alternative prophylaxis for Pneumocystis pneumonia (PCP) in pediatric oncology patients who cannot tolerate trimethoprim-sulfamethoxazole. This study found a 1.3% PCP breakthrough rate, indicating its viability as a second-line treatment.

Area of Science:

  • Oncology
  • Infectious Diseases
  • Pediatrics

Background:

  • Pneumocystis jirovecii pneumonia (PCP) is a significant threat to pediatric oncology patients.
  • Trimethoprim-sulfamethoxazole (TMP-SMZ) is the preferred PCP prophylaxis but is often not tolerated.
  • Intravenous pentamidine is used as a second-line prophylaxis option.

Purpose of the Study:

  • To determine the breakthrough rate of PCP in pediatric oncology patients receiving intravenous pentamidine as second-line prophylaxis.
  • To assess the safety and efficacy of intravenous pentamidine in this high-risk population.

Main Methods:

  • Retrospective chart review of pediatric oncology patients who received intravenous pentamidine between 2001 and 2006.
  • Analysis of patient diagnosis, age, and bone marrow transplant (BMT) status.
  • Review of records to determine reasons for discontinuing TMP-SMZ and confirmation of PCP diagnosis via bronchoscopy.

Main Results:

  • A total of 232 patients received 1,706 doses of intravenous pentamidine without identified toxicities.
  • The overall PCP breakthrough rate was 1.3% (3 out of 232 patients).
  • Higher breakthrough rates were observed in bone marrow transplant (BMT) patients (1.9%) and children under two years old (6.5%).

Conclusions:

  • Intravenous pentamidine demonstrates an acceptably low failure rate (1.3%) as a second-line PCP prophylaxis in pediatric oncology patients.
  • It is a viable option for high-risk patients, including those with BMT history.
  • Alternative prophylaxis strategies should be considered for children under two years of age due to a higher breakthrough rate.
Abstract

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