Pentamidine for Prophylaxis against Pneumocystis jirovecii Pneumonia in Pediatric Oncology Patients Receiving Immunosuppressive Chemotherapy

Abstract

<i>Pneumocystis jirovecii</i> pneumonia is a life-threatening opportunistic infection in children receiving immunosuppressive chemotherapy. Without prophylaxis, up to 25% of pediatric oncology patients receiving chemotherapy will develop <i>Pneumocystis jirovecii</i> pneumonia. Trimethoprim-sulfamethoxazole is the preferred agent for prophylaxis against <i>Pneumocystis jirovecii</i> pneumonia. Pentamidine may be an acceptable alternative for pediatric patients unable to tolerate trimethoprim-sulfamethoxazole. A retrospective review was conducted of pediatric oncology patients who received ≥1 dose of pentamidine for <i>Pneumocystis jirovecii</i> pneumonia prophylaxis between January 2007 and August 2014. Electronic medical records were reviewed to determine the incidence of breakthrough <i>Pneumocystis jirovecii</i> pneumonia or discontinuation of pentamidine associated with adverse events. A total of 754 patients received pentamidine prophylaxis during the period. There were no cases of probable or proven <i>Pneumocystis</i> pneumonia, and 4 cases (0.5%) of possible <i>Pneumocystis</i> pneumonia. The incidence of possible breakthrough <i>Pneumocystis</i> pneumonia was not significantly different between subgroups based on age (<12 months [1.7%] versus ≥12 months [0.4%], <i>P</i> = 0.3), route of administration (aerosolized [0%] versus intravenous [1.0%], <i>P</i> = 0.2), or hematopoietic stem cell transplant status (transplant [0.4%] versus no transplant [0.8%], <i>P</i> = 0.6). Pentamidine was discontinued due to an adverse drug event in 23 children (3.1%), more frequently for aerosolized than for intravenous administration (7.6% versus 2.2%, respectively, <i>P</i> = 0.004). Intravenous or inhaled pentamidine may be a safe and effective second-line alternative for prophylaxis against <i>Pneumocystis jirovecii</i> pneumonia in children with cancer receiving immunosuppressive chemotherapy or hematopoietic stem cell transplantation.