title: Efficacy of once-weekly dapsone dosing for Pneumocystis jirovecii pneumonia prophylaxis post transplantation.
abstract: BACKGROUND
  Pneumocystis jirovecii pneumonia (PCP) remains a concern after organ transplantation. In 2005, the University of Kentucky (UK) Transplant Center implemented a novel dosing regimen of weekly dapsone as an alternative for patients with contraindications or intolerability to trimethoprim-sulfamethoxazole (TMP-SMZ), which remains the drug of choice. The purpose of this study was to compare the efficacy of weekly dapsone with TMP-SMZ in preventing PCP post transplantation.
  
  
  METHODS
  A single-center, cohort, retrospective review of kidney and liver transplant patients from January 2005 to December 2012 was conducted. Patients who were identified as dapsone cases were matched in a 1:1 ratio with TMP-SMZ controls based on type of transplant, age, primary diagnosis, and gender. The primary endpoint assessed was the diagnosis of PCP at 6 and 12 months post transplant.
  
  
  RESULTS
  A total of 158 patients were included in the study. No documented cases of PCP occurred in either study group at 6 or 12 months (P = 1.0). In dapsone patients 35 (44%) cases of breakthrough infection occurred, compared to 24 (30%) in the TMP-SMZ group (P = 0.07) within 12 months post transplant. In the dapsone group, 52 (65%) patients were hospitalized within 6 months post transplant compared to 36 (46%) patients in the TMP-SMZ group (P = 0.01). Similar results were seen in patients hospitalized within 12 months post transplant; 49% of patients were switched from TMP-SMZ to dapsone owing to renal dysfunction.
  
  
  CONCLUSIONS
  No documented cases of PCP occurred in either study group. Future studies are warranted to show the efficacy of weekly dapsone dosing compared to other PCP prophylaxis regimens.
authors.affiliation: Department of Pharmacy Services, University of Kentucky Healthcare, Lexington, Kentucky, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Evans
authors.affiliation: Department of Pharmacy Services, University of Kentucky Healthcare, Lexington, Kentucky, USA.|University of Kentucky College of Pharmacy, Lexington, Kentucky, USA.
authors.forename: T M
authors.initials: TM
authors.lastname: Clifford
authors.affiliation: Department of Pharmacy Services, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: S
authors.initials: S
authors.lastname: Tang
authors.affiliation: University of Kentucky College of Pharmacy, Lexington, Kentucky, USA.
authors.forename: T
authors.initials: T
authors.lastname: Au
authors.affiliation: Department of Pharmacy Services, University of Kentucky Healthcare, Lexington, Kentucky, USA.|University of Kentucky College of Pharmacy, Lexington, Kentucky, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Fugit
mesh_terms: D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use; D015331:Cohort Studies; D003622:Dapsone / Q000008:administration & dosage* / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D009894:Opportunistic Infections / Q000517:prevention & control; D016377:Organ Transplantation; D045363:Pneumocystis carinii; D011020:Pneumonia, Pneumocystis / Q000517:prevention & control*; D012189:Retrospective Studies; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D000890:Anti-Infective Agents; D007166:Immunosuppressive Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D003622:Dapsone
keywords: PCP; Pneumocystis; dapsone; pneumonia; prophylaxis; transplant