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Clindamycin-primaquine for pneumocystis jiroveci pneumonia in renal transplant patients.
- Source :
- Infection; Dec2014, Vol. 42 Issue 6, p981-989, 9p, 1 Diagram, 5 Charts
- Publication Year :
- 2014
-
Abstract
- Background: Trimethoprim/sulfamethoxazole (TMP/SMX) is considered first-line therapy for pneumocystis jiroveci pneumonia (PCP) in renal transplant patients. Alternatives have not been formally studied. Clindamycin-primaquine (C-P) is effective in HIV-associated PCP, but data in renal transplant patients are lacking. Patients and methods: Retrospective cohort study of 57 consecutive renal transplant patients who developed PCP and were treated with C-P ( n = 23) or TMP/SMX ( n = 34). Results: A non-significantly higher failure rate was observed in patients on C-P due to lack of efficacy (30.4 versus 20.6 %, p = 0.545). The difference was more pronounced in severe PCP (60 versus 37.5 %, p = 0.611) and a significantly lower efficacy of C-P was seen when used as salvage therapy. The two patients who had received C-P after not responding to TMP/SMX failed this regimen, but all seven patients who had failed initial treatment with C-P and had been switched to TMP/SMX were cured ( p = 0.028). No treatment-limiting adverse reactions were reported for patients on C-P while six patients (17.6 %) on TMP/SMX developed possibly related treatment-limiting toxicity ( p = 0.071). However, in only two patients adverse events were definitely related to TMP/SMX (5.9 %). Conclusions: Clindamycin-primaquine appears to be safe and well tolerated for treating PCP in renal transplant patients but is probably less effective than TMP/SMX, the standard regimen. However, our data indicates that C-P represents an acceptable alternative for patients with contraindications or treatment emergent toxicities during TMP/SMX use. Notably, TMP/SMX was also acceptably tolerated in most patients. TMP/SMX remains an effective salvage regimen in case of C-P failure. [ABSTRACT FROM AUTHOR]
- Subjects :
- CLINDAMYCIN
CO-trimoxazole
PRIMAQUINE
ACADEMIC medical centers
COMBINATION drug therapy
FISHER exact test
KIDNEY transplantation
HEALTH outcome assessment
PNEUMOCYSTIS pneumonia
STATISTICAL hypothesis testing
TRANSPLANTATION of organs, tissues, etc.
TREATMENT effectiveness
RETROSPECTIVE studies
DESCRIPTIVE statistics
MANN Whitney U Test
THERAPEUTICS
Subjects
Details
- Language :
- English
- ISSN :
- 03008126
- Volume :
- 42
- Issue :
- 6
- Database :
- Complementary Index
- Journal :
- Infection
- Publication Type :
- Academic Journal
- Accession number :
- 99347283
- Full Text :
- https://doi.org/10.1007/s15010-014-0660-y