title: Single-day trimethoprim/sulfamethoxazole prophylaxis for Pneumocystis pneumonia in children with cancer.
abstract: OBJECTIVE
  To determine whether a simplified, 1-day/week regimen of trimethoprim/sulfamethoxazole is sufficient to prevent Pneumocystis (jirovecii [carinii]) pneumonia (PCP). Current recommended regimens for prophylaxis against PCP range from daily administration to 3 consecutive days per week dosing.
  
  
  METHODS
  A prospective survey of the regimens adopted for the PCP prophylaxis in all patients treated for childhood cancer at pediatric hematology-oncology centers of the Associazione Italiana Ematologia Oncologia Pediatrica.
  
  
  RESULTS
  The 20 centers participating in the study reported a total of 2466 patients, including 1093 with solid tumor and 1373 with leukemia/lymphoma (or primary immunodeficiency; n = 2). Of these patients, 1371 (55.6%) received the 3-day/week prophylaxis regimen, 406 (16.5%) received the 2-day/week regimen, and 689 (27.9%), including 439 with leukemia/lymphoma, received the 1-day/week regimen. Overall, only 2 cases of PCP (0.08%) were reported, both in the 2-day/week group. By intention to treat, the cumulative incidence of PCP at 3 years was 0.09% overall (95% CI, 0.00-0.40%) and 0.51% for the 2-day/week group (95% CI, 0.10%-2.00%). Remarkably, both patients who failed had withdrawn from prophylaxis.
  
  
  CONCLUSIONS
  A single-day course of prophylaxis with trimethoprim/sulfamethoxazole may be sufficient to prevent PCP in children with cancer undergoing intensive chemotherapy regimens. This simplified strategy might have implications for the emerging need for PCP prophylaxis in other patients subjected to the increased use of biological and nonbiological agents that induce higher levels of immune suppression, such as those with rheumatic diseases.
authors.affiliation: Department of Pediatric Hematology-Oncology, Azienda Ospedaliero Universitaria Meyer Children Hospital, Florence, Italy.
authors.forename: Désirée
authors.initials: D
authors.lastname: Caselli
authors.affiliation: Pediatric Hematology-Oncology, Padua, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Petris
authors.affiliation: Pediatric Oncology and Hematology, Lalla Seràgnoli Unit, University of Bologna, Bologna, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Rondelli
authors.affiliation: Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Turin, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Carraro
authors.affiliation: Pediatric Hematology-Oncology, Monza, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Colombini
authors.affiliation: Pediatric Hematology-Oncology, Bari, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Muggeo
authors.affiliation: Pediatric Hematology-Oncology, ARNAS Civico, Palermo, Italy.
authors.forename: Ottavio
authors.initials: O
authors.lastname: Ziino
authors.affiliation: Pediatric Oncology and Hematology, Lalla Seràgnoli Unit, University of Bologna, Bologna, Italy.
authors.forename: Fraia
authors.initials: F
authors.lastname: Melchionda
authors.affiliation: Pediatric Hematology-Oncology, Catania, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Russo
authors.affiliation: Division of Pediatric Hematology/Oncology, G Salesi Women's and Children's Hospital, Ancona, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pierani
authors.affiliation: Pediatric Hematology-Oncology, BMT Unit, Spedali Civili, Brescia, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Soncini
authors.affiliation: Pediatric Hematology-Oncology, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: DeSantis
authors.affiliation: Pediatric Hematology-Oncology, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Zanazzo
authors.affiliation: Pediatric and Hematology-Oncology, University Hospital Azienda Ospedaliero Universitaria di Parma, Parma, Italy.
authors.forename: Angelica
authors.initials: A
authors.lastname: Barone
authors.affiliation: Pediatric Hematology-Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Cesaro
authors.affiliation: Pediatric Hematology-Oncology, University Hospital, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Cellini
authors.affiliation: Pediatric Hematology-Oncology, Cagliari, Italy.
authors.forename: Rossella
authors.initials: R
authors.lastname: Mura
authors.affiliation: Pediatric Oncology/Hematology, BMT Unit, Section of Hematology, Department of Internal and Experimental Medicine, University of Perugia, Perugia, Italy.
authors.forename: Giuseppe M
authors.initials: GM
authors.lastname: Milano
authors.affiliation: Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionaledei Tumori, Milan, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Meazza
authors.affiliation: Pediatric Immunology, San Raffaele Telethon Institute for Gene Therapy, Milan, Italy.
authors.forename: Maria P
authors.initials: MP
authors.lastname: Cicalese
authors.affiliation: Pediatric Hematology-Oncology, ARNAS Civico, Palermo, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Tropia
authors.affiliation: Epidemiology, Azienda Ospedaliero Universitaria Meyer Children Hospital, Florence, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: De Masi
authors.affiliation: Infectious Disease Unit, Gaslini Institute, Istituto Giannina Gaslini, Genoa, Italy.
authors.forename: Elio
authors.initials: E
authors.lastname: Castagnola
authors.affiliation: Department of Pediatric Hematology-Oncology, Azienda Ospedaliero Universitaria Meyer Children Hospital, Florence, Italy. Electronic address: maurizio.arico@ittumori.it.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Aricò
mesh_terms: D000890:Anti-Infective Agents / Q000008:administration & dosage; D002648:Child; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D045363:Pneumocystis carinii / Q000302:isolation & purification*; D011020:Pneumonia, Pneumocystis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage*
chemical_list: D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
keywords: AIEOP; Associazione Italiana Ematologia Oncologia Pediatrica; PCP; Pneumocystis (jirovecii [carinii]) pneumonia; SMX; Sulfamethoxazole; TMP; Trimethoprim