Preventive effect of sulfamethoxasole-trimethoprim on Pneumocystis jiroveci pneumonia in patients with interstitial pneumonia.
BACKGROUND
Pneumocystis jiroveci pneumonia (PCP) is a potentially fatal complication in interstitial pneumonia patients receiving glucocorticoid therapy. Prophylaxis of PCP during glucocorticoid therapy is an important issue in the treatment of interstitial pneumonia.


OBJECTIVE
We evaluated the prophylactic effect of sulfamethoxasole-trimethoprim (TMP-SMX) in interstitial pneumonia patients receiving glucocorticoids.


METHODS
We retrospectively analyzed 74 interstitial pneumonia patients who received glucocorticoid therapy.


RESULTS
Seven of the 74 patients developed PCP. At the time of diagnosis of PCP, the mean duration of glucocorticoid therapy was 71 days and the mean daily dose of prednisolone was 37 mg. Among the 7 patients, the circulating CD4+ lymphocyte count was 370 /microl on average and it was over 200 /microl in 3 cases. The PCP patients showed a significant reduction of the lymphocyte count at 4 weeks after initiation of steroid therapy. None of the patients who received prophylactic TMP-SMX therapy developed PCP even if the CD4+ lymphocyte count was less than 200 /microl.


CONCLUSIONS
Interstitial pneumonia patients receiving glucocorticoid therapy can benefit from TMP-SMX prophylaxis against PCP. Development of PCP cannot be ruled out in patients with a CD4+ lymphocyte count of greater than 200 /microl.
Enomoto
Tatsuji
T
Department of Respiratory Medicine, Tokyo Metropolitan Hiroo General Hospital, Tokyo.
Azuma
Arata
A
Matsumoto
Aki
A
Nei
Takahito
T
Fujita
Kazue
K
Hattori
Kumiko
K
Saito
Yoshinobu
Y
Abe
Shinji
S
Usuki
Jiro
J
Kudoh
Shoji
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D018791:CD4 Lymphocyte Count; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D045363:Pneumocystis carinii; D011020:Pneumonia, Pneumocystis / Q000000981:diagnostic imaging / Q000382:microbiology / Q000517:prevention & control*; D011239:Prednisolone / Q000009:adverse effects; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*
D000890:Anti-Infective Agents; D005938:Glucocorticoids; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D011239:Prednisolone