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Twice Weekly Sulfamethoxazole/Trimethoprim for Pneumocystis jiroveci Pneumonia Prophylaxis in Lung Transplant
Chloe Munroe1, Alissa Chan1, Morgan Eiting1
1University of Utah Health, Salt Lake City, Utah, USA.
Background:
Pneumocystis jiroveci pneumonia (PJP) prophylaxis is recommended indefinitely for lung transplant recipients (LTR). To mitigate the side effects of oral sulfamethoxazole-trimethoprim (SMX/TMP) in LTR, our center prescribes SMX/TMP single-strength (SS) twice weekly for PJP prophylaxis. To our knowledge, this regimen has not been evaluated in the literature. We sought to determine the incidence of PJP infection and SMX/TMP discontinuation in LTR taking this regimen. METHODS: This retrospective review evaluated LTR first single or bilateral lung transplant at our center from June 1, 2014 to September 1, 2022. Data was obtained from the United Network of Organ Sharing Data Reports and chart review. The primary outcome was the incidence of PJP infection in LTR taking SMX/TMP SS twice weekly at index discharge until 5 years post-lung transplant, graft failure, or last data point, whichever came first. Secondary outcomes assessed SMX/TMP discontinuation, provider rationale for discontinuation, and alternative PJP prophylaxis.
Results:
A total of 105 patients were included in the analysis. No cases of PJP were seen with SMX/TMP SS twice weekly. SMX/TMP was discontinued in 23 LTR during the study period. By the end of the study period, 43% transitioned back to SMX/TMP SS twice weekly. The overall incidence of indefinite SMX/TMP discontinuation was 12%. Leukopenia was the most common reason for discontinuation. Dapsone was the most common alternative prophylactic agent.
Conclusion:
Our retrospective review of SMX/TMP SS twice weekly for PJP prophylaxis resulted in no PJP infection and may reduce indefinite SMX/TMP discontinuation in LTR.
Insights
Lung transplant recipients on twice-weekly sulfamethoxazole-trimethoprim (SMX/TMP) had no Pneumocystis jiroveci pneumonia (PJP) infections. This regimen may also lower long-term SMX/TMP discontinuation rates in these patients.
Area of Science:
- Pulmonology
- Infectious Diseases
- Transplantation Medicine
Background:
- Lung transplant recipients (LTR) require indefinite Pneumocystis jiroveci pneumonia (PJP) prophylaxis.
- Oral sulfamethoxazole-trimethoprim (SMX/TMP) is standard but has side effects.
- A twice-weekly single-strength (SS) SMX/TMP regimen was evaluated for PJP prophylaxis in LTR.
Purpose of the Study:
- To determine the incidence of PJP infection in LTR on a twice-weekly SMX/TMP SS regimen.
- To assess the rate of SMX/TMP discontinuation in LTR receiving this prophylaxis.
- To identify reasons for SMX/TMP discontinuation and alternative prophylaxis used.
Main Methods:
- Retrospective review of LTR who underwent transplant between June 2014 and September 2022.
- Data collected from United Network of Organ Sharing and chart reviews.
- Primary outcome: PJP infection incidence; Secondary outcomes: SMX/TMP discontinuation, reasons, and alternatives.
Main Results:
- No cases of PJP were observed in 105 LTR on the twice-weekly SMX/TMP SS regimen.
- SMX/TMP was discontinued in 23% of patients; 12% had indefinite discontinuation.
- Leukopenia was the most common discontinuation reason; dapsone was the frequent alternative.
Conclusions:
- The twice-weekly SMX/TMP SS regimen for PJP prophylaxis in LTR resulted in zero PJP infections.
- This regimen may potentially decrease the rate of indefinite SMX/TMP discontinuation in LTR.
- Further studies are warranted to confirm these findings and optimize PJP prophylaxis strategies.
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