title: Intravenous pentamidine is effective as second line Pneumocystis pneumonia prophylaxis in pediatric oncology patients.
abstract: BACKGROUND
  Pneumocystis jirovecii, formerly carinii, pneumonia (PCP) poses a life-threatening risk to oncology patients. The use of trimethoprim-sulfamethoxazole (TMP-SMZ) prophylaxis virtually eliminates the risk of infection; however, many patients cannot tolerate TMP-SMZ. We performed a retrospective analysis to determine the PCP breakthrough rate in pediatric oncology patients receiving intravenous pentamidine as second line PCP prophylaxis.
  
  
  METHODS
  We conducted a retrospective chart review of pediatric oncology patients who received intravenous pentamidine from 2001 to 2006 at our institution. The diagnosis, age and bone marrow transplant (BMT) status were determined. A subset of patients had review of their records to determine the justification for discontinuing TMP-SMZ. Children who developed symptoms of pneumonia with a clinical suspicion of PCP underwent bronchoscopy, allowing for identification of Pneumocystis.
  
  
  RESULTS
  A total of 232 patients received 1,706 doses of intravenous pentamidine and no toxicities were identified. The main reasons for discontinuing TMP-SMZ were bone marrow suppression and drug allergy. Three children developed PCP, equating to a breakthrough rate of 1.3%. Two of these children had undergone BMT (1.9% breakthrough rate) and both were under the age of two (6.5% breakthrough rate).
  
  
  CONCLUSIONS
  The use of intravenous pentamidine as PCP prophylaxis results in a breakthrough rate of 1.3%. TMP-SMZ is the first choice for PCP prophylaxis. However, when necessary, the use of intravenous pentamidine has an acceptably low failure rate, even in high-risk BMT patients. Other options should be considered for children less than 2 years of age.
authors.affiliation: Division of Pediatric Oncology, Department of Oncology, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Su Young
authors.initials: SY
authors.lastname: Kim
authors.forename: Alix A
authors.initials: AA
authors.lastname: Dabb
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Glenn
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Snyder
authors.forename: Meredith K
authors.initials: MK
authors.lastname: Chuk
authors.forename: David M
authors.initials: DM
authors.lastname: Loeb
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage*; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D007275:Injections, Intravenous; D009369:Neoplasms / Q000628:therapy; D010419:Pentamidine / Q000008:administration & dosage*; D011020:Pneumonia, Pneumocystis / Q000276:immunology* / Q000517:prevention & control*; D012189:Retrospective Studies; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects
chemical_list: D000935:Antifungal Agents; D010419:Pentamidine; D015662:Trimethoprim, Sulfamethoxazole Drug Combination