title: A systematic review of two different trimetoprim-sulfamethoxazole regimens used to prevent Pneumocystis jirovecii and no prophylaxis at all in transplant recipients: appraising the evidence.
abstract: BACKGROUND
  The aim of this study was to clarify the potential advantages of a low-dose regimen of trimethoprim-sulfamethoxazole prophylaxis to prevent Pneumocystis jirovecii pneumonia (PJP) in transplant recipients (80/400 mg/d every day or 160/800 mg/d every other day) with those obtained from the full-dose prophylaxis (160/800 mg/d every day) or no prophylaxis.
  
  
  METHODS
  Prospectively randomized and retrospectively case controlled studies were selected.
  
  
  RESULTS
  Four studies matched the inclusion criteria-2 randomized and 2 case controls-for a total of 570 patients. The pneumonia incidence was 0% after full-dose prophylaxis (0/181), 1% after the low-dose regimen (1/105), and 11% with no prophylaxis (31/284). Pneumonia occurrences were significant lower between the full-dose prophylaxis versus the no prophylaxis group (0% vs 11%; P < .001), and between the low-dose and no prophylaxis groups (1% vs 11%; P < .001). There was no difference between patients receiving the full-dose prophylaxis versus the low-dose regimen (0% vs 1%; P = NS).
  
  
  CONCLUSIONS
  The low-dose gives similar results as the full-dose regimen for the prevention of PJP and seems a feasible, safe option for transplanted patients.
authors.affiliation: Transplant and Renal Failure Surgery Unit, San Salvatore Hospital, University of L'Aquila, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Di Cocco
authors.forename: G
authors.initials: G
authors.lastname: Orlando
authors.forename: L
authors.initials: L
authors.lastname: Bonanni
authors.forename: M
authors.initials: M
authors.lastname: D'Angelo
authors.forename: K
authors.initials: K
authors.lastname: Clemente
authors.forename: S
authors.initials: S
authors.lastname: Greco
authors.forename: G
authors.initials: G
authors.lastname: Gravante
authors.forename: F
authors.initials: F
authors.lastname: Madeddu
authors.forename: C
authors.initials: C
authors.lastname: Scelzo
authors.forename: A
authors.initials: A
authors.lastname: Famulari
authors.forename: F
authors.initials: F
authors.lastname: Pisani
mesh_terms: D000890:Anti-Infective Agents / Q000008:administration & dosage*; D006801:Humans; D045363:Pneumocystis carinii; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy*; D066027:Transplant Recipients; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination