title: Atovaquone versus trimethoprim-sulfamethoxazole as Pneumocystis jirovecii pneumonia prophylaxis following renal transplantation.
abstract: Pneumocystis pneumonia (PCP) is associated with significant morbidity and mortality in renal transplant recipients (RTR). Trimethoprim-sulfamethoxazole (TMP-SMZ) is considered the prophylactic agent-of-choice. Some patients require an alternative owing to TMP-SMZ intolerance. This is the first evaluation of full-dose atovaquone vs. TMP-SMZ for PCP prevention in RTR. One hundred and eighty-five RTR were evaluated in this single-center, retrospective analysis. Patients received either single-strength TMP-SMZ daily (group I; n = 160) or 1500 mg/d of atovaquone and of a fluoroquinolone for one month (group II; n = 25). The primary endpoint was the incidence of PCP at 12 months post-transplant. There were no cases of PCP in either group. There were comparable rates of infections from bacterial pathogens and cytomegalovirus, but rates of BK viremia were significantly higher in group I (22.5%) vs. group II (4%; p = 0.03). The incidence of leukopenia was similar in both groups. Higher mean potassium levels were seen in group I at three months post-transplant but were comparable at all other time points. The need for dose reduction and/or premature discontinuation of therapy secondary to adverse events was more prevalent in TMP-SMZ-treated patients. In our experience, atovaquone appears to be effective in preventing PCP post-renal transplant and also demonstrates good tolerability.
authors.affiliation: Department of Transplant Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA. sgabardi@partners.org
authors.forename: Steven
authors.initials: S
authors.lastname: Gabardi
authors.forename: Peter
authors.initials: P
authors.lastname: Millen
authors.forename: Shelley
authors.initials: S
authors.lastname: Hurwitz
authors.forename: Spencer
authors.initials: S
authors.lastname: Martin
authors.forename: Keri
authors.initials: K
authors.lastname: Roberts
authors.forename: Anil
authors.initials: A
authors.lastname: Chandraker
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D053626:Atovaquone / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000382:microbiology / Q000628:therapy*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D045363:Pneumocystis carinii / Q000472:pathogenicity*; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy* / Q000382:microbiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*
chemical_list: D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D053626:Atovaquone