title: Intravenous pentamidine is safe and effective as primary pneumocystis pneumonia prophylaxis in children and adolescents undergoing hematopoietic stem cell transplantation.
abstract: BACKGROUND
  Pneumocystis carinii pneumonia (PCP) is a potentially life-threatening but preventable infection that may occur after hematopoietic stem cell transplantation (HSCT). Intravenous pentamidine has been used in the prevention of PCP in the post-transplant period, although there are few trials published in the literature evaluating its safety and efficacy.
  
  
  METHODS
  We retrospectively reviewed the medical records of children who underwent HSCT from January 1, 2005, to October 1, 2011, who received intravenous pentamidine as first-line PCP prophylaxis initiated at admission. Demographic, clinical, microbiologic, management and outcome data were collected.
  
  
  RESULTS
  One hundred sixty-seven consecutive HSCTs in 137 pediatric patients were given intravenous pentamidine before myeloablation and then every 28 days until the subject was at least a minimum 30 days post-HSCT, had stable neutrophil engraftment (absolute neutrophil count >1000/mm for 3 days without growth factor support) and for allogeneic patients, no evidence of active graft versus host disease and weaning on their immunosuppressive therapy. No cases of PCP were seen in this cohort. Ten (7%) had a grade I side effect of nausea/vomiting requiring slower infusion time and 2 (2%) had a grade IV reaction with anaphylaxis (rash) and hypotension with 1 child requiring transfer to the intensive care unit.
  
  
  CONCLUSIONS
  Intravenous pentamidine was safe and effective for the prevention of PCP in pediatric HSCT patients. Given the potential neutropenic effects of trimethoprim-sulfamethoxazole, compliance with drug administration and inferior efficacy of other PCP prophylactic medications, intravenous pentamidine should be considered as first-line therapy for the prevention of PCP in children undergoing HSCT.
authors.affiliation: From the *Children's Medical Center Dallas, Dallas, TX; †Huntsville Hospital for Women and Children, Huntsville, AL; and ‡University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: James M
authors.initials: JM
authors.lastname: DeMasi
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Cox
authors.forename: David
authors.initials: D
authors.lastname: Leonard
authors.forename: Andrew Y
authors.initials: AY
authors.lastname: Koh
authors.forename: Victor M
authors.initials: VM
authors.lastname: Aquino
mesh_terms: D061605:Administration, Intravenous / Q000009:adverse effects; D000293:Adolescent; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects; D018890:Chemoprevention / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D010419:Pentamidine / Q000008:administration & dosage* / Q000009:adverse effects; D045363:Pneumocystis carinii / Q000187:drug effects; D011020:Pneumonia, Pneumocystis / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D010419:Pentamidine