title: Complications and outcomes of trimethoprim-sulphamethoxazole as chemoprophylaxis for pneumocystis pneumonia in renal transplant recipients.
abstract: BACKGROUND
  Following a pneumocystis pneumonia (PCP) outbreak in our nephrology unit, all transplant patients were offered chemoprophylaxis with trimethoprim-sulphamethoxazole (TMP-SMX) as the first line agent. A high rate of complications was noted. We aimed to quantify TMP-SMX associated adverse events and evaluate its prophylactic benefit in their light. Potential risk factors for complications' development were also investigated.
  
  
  METHODS
  This was an observational study of outcomes in transplant recipients commenced on TMP-SMX prophylaxis for 1year period. End-points were adverse events due to TMP-SMX, the additional medical burden resulting from these events, and PCP diagnosis.
  
  
  RESULTS
  290 patients commenced on TMP-SMX. 110 (38%) developed complications with most common being rise in serum creatinine (Cr) (n = 63, 22%) followed by gastrointestinal symptoms (n = 15, 5%), and leucopenia (n = 5, 2%). PCP incidence fell from 19 cases in 19 months to 2 cases in 12 months. Baseline renal function (P = 0.019) was an independent predictors for developing rise in Cr with TMP-SMX.
  
  
  CONCLUSIONS
  Use of chemoprophylaxis is an effective strategy in dealing with a PCP outbreak but can lead to a high number of complications. Rises in serum Cr can cause significant concern and increase in the number of investigations.
authors.affiliation: Nephrology Department, Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: Nicos
authors.initials: N
authors.lastname: Mitsides
authors.forename: Kerry
authors.initials: K
authors.lastname: Greenan
authors.forename: Darren
authors.initials: D
authors.lastname: Green
authors.forename: Rachel
authors.initials: R
authors.lastname: Middleton
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lamerton
authors.forename: Judith
authors.initials: J
authors.lastname: Allen
authors.forename: Jane
authors.initials: J
authors.lastname: Redshaw
authors.forename: Paul R
authors.initials: PR
authors.lastname: Chadwick
authors.forename: Chinari Pk
authors.initials: CP
authors.lastname: Subudhi
authors.forename: Grahame
authors.initials: G
authors.lastname: Wood
mesh_terms: D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000009:adverse effects*; D018890:Chemoprevention; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011020:Pneumonia, Pneumocystis / Q000517:prevention & control*; D016016:Proportional Hazards Models; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects*
chemical_list: D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D003404:Creatinine
keywords: adverse events; pneumocystis pneumonia; transplantation; trimethoprim-sulphamethoxazole