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- Title
Clindamycin-primaquine for pneumocystis jiroveci pneumonia in renal transplant patients.
- Authors
Nickel, P.; Schürmann, M.; Albrecht, H.; Schindler, R.; Budde, K.; Westhoff, T.; Millward, J.; Suttorp, N.; Reinke, P.; Schürmann, D.
- 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.
- Subjects
GERMANY; 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
- Publication
Infection, 2014, Vol 42, Issue 6, p981
- ISSN
0300-8126
- Publication type
Article
- DOI
10.1007/s15010-014-0660-y