Is There a Role for Opportunistic Infection Prophylaxis in Pemphigus? An Expert Survey.
BACKGROUND
Opportunistic infections (OIs) are a dreaded adverse effect of immunosuppressive therapy, leading to the use of opportunistic infection prophylaxis (OIP) in many immunosuppressed conditions. However, guidelines for OIP in pemphigus are lacking.


OBJECTIVE
Our objective was to evaluate the approach of leading pemphigus experts towards OIP.


METHODS
We conducted an online survey of OIP trends.


RESULTS
The survey was completed by 33 experts. Prior to initiation of immunosuppressive therapy, 75% routinely screened for hepatitis viruses, and at least half screened for HIV or tuberculosis. Most experts (76%) prescribed OIP but to <10% of their patients, and the most frequent drugs of choice were sulfamethoxazole/trimethoprim and acyclovir. Most experts agreed that treatment with three or more immunosuppressive agents or a previous history of OIs would lead to the use of OIP that was then discontinued with cessation of immunosuppression. The arguments against OIP were the lack of evidence for its necessity and concern about side effects or emergence of resistant pathogens. The surveyed experts treated patients with severe disease in a tertiary care setting, which may have led to an overestimation of the use of OIP. Infectious disease specialists were not included.


CONCLUSIONS
Substantial disparities exist in approaches to OIP for patients with pemphigus, including the decision to treat, type of treatment, and risk stratification among pemphigus experts.
Department of Dermatology, Beilinson Hospital, Derech Ze'ev Jabotinsky 39, Petach Tikva, 4941492, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Yael A
YA
Leshem
Department of Dermatology, Beilinson Hospital, Derech Ze'ev Jabotinsky 39, Petach Tikva, 4941492, Israel.
Igor
I
Snast
Schneider Children's Medical Center, Petach Tikva, Israel.
Rivka
R
Friedland
Department of Dermatology, Beilinson Hospital, Derech Ze'ev Jabotinsky 39, Petach Tikva, 4941492, Israel.
Lihi
L
Atzmony
Department of Dermatology, Beilinson Hospital, Derech Ze'ev Jabotinsky 39, Petach Tikva, 4941492, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Assi
A
Levi
Department of Dermatology, Beilinson Hospital, Derech Ze'ev Jabotinsky 39, Petach Tikva, 4941492, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Emmilia
E
Hodak
Department of Dermatology, Beilinson Hospital, Derech Ze'ev Jabotinsky 39, Petach Tikva, 4941492, Israel. daniel.mimouni@gmail.com.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. daniel.mimouni@gmail.com.
Daniel
D
Mimouni
D019538:Health Care Surveys; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D008403:Mass Screening / Q000379:methods; D009894:Opportunistic Infections / Q000209:etiology / Q000517:prevention & control*; D010392:Pemphigus / Q000150:complications / Q000628:therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*
D007166:Immunosuppressive Agents