Pneumocystis carinii Pneumonia Prophylaxis

Abstract

Pneumocystis pneumonia (PCP) can be life threatening for children receiving chemotherapy and immunosuppressive medication, including high-dose steroids. Although there are no current guidelines for prophylaxis in pediatric oncology patients, ongoing studies are evaluating the efficacy, side effects, ease of administration, and compliance of drugs used for PCP prophylaxis. Drugs currently being prescribed in practice include Bactrim, pentamidine, dapsone, and atovaquone. Bactrim remains superior for preventing PCP, but alternatives are being analyzed and investigated for those unable to tolerate Bactrim because of drug allergy or side effects. Educating patients and families about the importance of PCP prophylaxis and compliance should be a priority for all health care providers caring for children receiving immunosuppressive medications, including chemotherapy.

Keywords

Pneumocystis jiroveci pneumocystis pneumonia prophylaxis

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References

Abidi

M. H.

Kozlowski

J. R.

Ibrahim

R. B.

Peres

(2006). The sulfone syndrome secondary to Dapsone prophylaxis in a patient undergoing unrelated hematopoietic stem cell transplantation. Hematological Oncology, 24, 164-165.

Aviles

Boyce

T. G.

Thompson

D. M.

(2004). Pneumocystis carinii pneumonia in a 3-month-old infant receiving high-dose corticosteroid therapy for airway hemangiomas. Mayo Clinic Proceedings, 79, 243-245.

Bachuss

C. A.

(2008). Glioblastoma multiforme: A case study. Internet Journal of Advanced Nursing Practice,9(2). Retrieved from http://www.ispub.com/journal/the_internet_journal_of_advanced_nursing_practice/volume_9_number_2_8/article/glioblastoma_multiforme_a_case_study.html

Bollée

Sarfati

Thiéry

Bergeron

de Miranda

Menotti

. . . Azoulay

(2007). Clinical picture of Pneumocystis jiroveci pneumonia in cancer patients. Chest, 132, 1305-1310.

Cotrimoxazole is generally used to manage Pneumocystis jiroveci pneumonia in children receiving chemotherapy. (2008). Drugs & Therapy Perspectives, 24(5), 9-12.

Green

Paul

Vidal

Leibovici

(2007a). Prophylaxis for pneumocystis pneumonia (PCP) in non-HIV immunocompromised patients. Cochrane Database of Systematic Reviews, (3): CD005590. doi:10.1002/14651858.CD005590.pub2

Green

Paul

Vidal

Leibovici

(2007b). Prophylaxis of pneumocystis pneumonia in immunocompromised non-HIV-infected patients: Systematic review and meta-analysis of randomized controlled trials. Mayo Clinic Proceedings, 82, 1052-1059.

Kim

S. Y.

Dabb

A. A.

Glenn

D. J.

Snyder

K. M.

Chuk

M. K.

Loeb

D. M.

(2008). Intravenous pentamidine is effective as second line pneumocystis pneumonia prophylaxis in pediatric oncology patients. Pediatric Blood & Cancer, 50, 779-783. doi:10.1002/pbc.21287

Libecco

J. A.

Powell

K. R.

(2004). Trimethoprim/sulfamethoxazole: Clinical update. Pediatrics in Review/American Academy of Pediatrics, 25, 375-380.

10.

Lindemulder

Albano

(2007). Successful intermittent prophylaxis with trimethoprim/sulfamethoxazole 2 days per week for Pneumocystis carinii (jiroveci) pneumonia in pediatric oncology patients. Pediatrics, 120, e47-51.

11.

Madden

R. M.

Pui

C. H.

Hughes

W. T.

Flynn

P. M.

Leung

(2007). Prophylaxis of Pneumocystis carinii pneumonia with Atovaquone in children with leukemia. Cancer, 109, 1654-1658. doi:10.1002/cncr.22562

12.

Milligan

K. S.

Phillips

D. L.

(2007). Perioral numbness associated with intravenous Pentamidine administration. Annals of Pharmacotherapy, 41, 153-156.

13.

Milstone

A. M.

Balakrishnan

S. L.

Foster

C. B.

Chen

(2006). Failure of intravenous pentamidine prophylaxis to prevent pneumocystis pneumonia in a pediatric hematopoietic stem cell transplant (HSCT) patient. Pediatr Blood Cancer. 47, 859-860.

14.

Ohata

Ohta

Hashii

Tokimasa

Ozono

Hara

(2009). Intermittent oral trimethoprim/sulfamethoxazole on two non-consecutive days per week is effective as Pneumocystis jiroveci pneumonia prophylaxis in pediatric patients receiving chemotherapy or hematopoietic stem cell transplantation. Pediatric Blood & Cancer, 52, 142-144. doi:10.1002/pbc.21774

15.

Prasad

Nania

J. J.

Shankar

S. M.

(2008). Pneumocystis pneumonia in children receiving chemotherapy. Pediatric Blood & Cancer, 50, 896-898. doi:10.1002/pbc.21202

16.

Pyrgos

Shoham

Roilides

Walsh

T. J.

(2009). Pneumocystis pneumonia in children. Paediatric Respiratory Reviews, 10, 192-198. doi:10.1016/j.prrv.2009.06.010

17.

Sangiolo

Storer

Nash

Corey

Davis

Flowers

. . . Boeckh

(2005). Toxicity and efficacy of daily dapsone as Pneumocystis jiroveci prophylaxis after hematopoietic stem cell transplantation: A case-control study. Biology of Blood and Marrow Transplantation: Journal of the American Society for Blood and Marrow Transplantation, 11, 521-529. doi:10.1016/j.bbmt.2005.04.011

18.

Shankar

S. M.

Nania

J. J.

(2007). Management of Pneumocystis jiroveci pneumonia in children receiving chemotherapy. Paediatric Drugs, 9, 301-309.

19.

Suryaprasad

Stone

J. H.

(2008). When is it safe to stop Pneumocystis jiroveci pneumonia prophylaxis? Insights from three cases complicating autoimmune diseases. Arthritis & Rheumatism, 59, 1034-1039.

20.

Williams

MacDonald

Hoyer

J. D.

Barr

R. D.

Athale

U. H.

(2005). Methemoglobinemia in children with acute lymphoblastic leukemia (ALL) receiving dapsone for Pneumocystis carinii pneumonia (PCP) prophylaxis: A correlation with cytochrome b5 reductase (Cb5R) enzyme levels. Pediatric Blood & Cancer, 44, 55-62. doi:10.1002/pbc.20164