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[Pneumocystis prophylaxis during glucocorticoid use?]

Quirijn de Mast1,2, Rogier Thurlings3, Jaap Ten Oever1

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|September 14, 2018
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Summary
This summary is machine-generated.

Pneumocystis jiroveci pneumonia (PJP) prophylaxis is debated for rheumatology patients on long-term, high-dose steroids. Trimethoprim/sulfamethoxazole (TMP/SMX) shows efficacy and safety in specific patient groups.

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Area of Science:

  • Immunology
  • Infectious Diseases
  • Rheumatology

Background:

  • Pneumocystis jiroveci pneumonia (PJP) is a serious risk for immunosuppressed patients.
  • Lack of consensus exists regarding PJP prophylaxis in rheumatology patients on prolonged, high-dose glucocorticoids.

Purpose of the Study:

  • To evaluate the efficacy and safety of PJP prophylaxis in rheumatology patients.
  • To inform decisions on PJP prophylaxis by considering Number Needed to Treat (NNT) vs. Number Needed to Harm (NNH).

Main Methods:

  • Retrospective study analyzing patients receiving immunosuppressive drugs.
  • Focus on patients using prednisone ≥ 30 mg for > 1 month.
  • Assessment of trimethoprim/sulfamethoxazole (TMP/SMX) use for prophylaxis.

Main Results:

  • Trimethoprim/sulfamethoxazole (TMP/SMX) demonstrated efficacy and safety in this patient cohort.
  • Patients using ≥ 30 mg prednisone for > 1 month, especially those with high-risk disease, may benefit.
  • The study supports TMP/SMX as a viable prophylactic option.

Conclusions:

  • Trimethoprim/sulfamethoxazole (TMP/SMX) is an effective and safe PJP prophylaxis option for select rheumatology patients.
  • Further surveillance and risk factor analysis can aid in developing national PJP prophylaxis protocols.