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Low-dose trimethoprim–sulfamethoxazole for Pneumocystis jiroveci pneumonia prophylaxis after allogeneic hematopoietic SCT

Bone Marrow Transplantation volume 46, pages 1573–1575 (2011)Cite this article

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Pneumocystis jiroveci pneumonia is a life-threatening infection that occurs after allo-SCT. Without prophylaxis, 5–16% of patients develop pneumocystis pneumonia with a median onset at 9 weeks after transplantation and a mortality rate of 76%.1 Risk factors for pneumocystis pneumonia after allo-SCT include immunosuppressive therapy, chronic GVHD, relapse of primary disease or low CD4+ T cell count (<200 cells per μL).2, 3, 4 As the introduction of trimethoprim–sulfamethoxazole as prophylaxis against pneumocystis, the incidence of pneumocystis pneumonia after allo-SCT has decreased to less than 5%, and most cases of the disease develop after discontinuation of the drug at more than 6 months after transplantation.1, 2, 3, 5 Alternative drugs include aerosolized pentamidine, dapsone and atovaquone;6 however, they are less effective than trimethoprim–sulfamethoxazole.5, 7, 8 Moreover, compared with prophylaxis with trimethoprim–sulfamethoxazole, that with aerosolized pentamidine is associated with increased mortality at 1 year after allo-SCT.8

Although trimethoprim–sulfamethoxazole is the most effective prophylactic drug for pneumocystis, its adverse effects, such as rash, marrow suppression, fever, and renal, gastrointestinal and liver dysfunction, are frequently observed and sometimes require discontinuation of the drug. One double-strength trimethoprim–sulfamethoxazole tablet (trimethoprim 160 mg per sulfamethoxazole 800 mg) daily, one single-strength tablet (80 mg per 400 mg) daily or one double-strength tablet q.d. thrice per week are recommended for pneumocystis prophylaxis following allo-SCT;9 however, the optimal dosage remains to be defined. Several attempts were made at lowering the dose of the drug without increasing the incidence of pneumocystis pneumonia, but considerable rates of discontinuation of the drug were still reported.8, 10

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Authors and Affiliations

  1. Department of Hematology, Chiba University Hospital, Chiba, Japan

    T Muto, M Takeuchi, T Kawaguchi, S Tanaka, S Tsukamoto, S Sakai, Y Takeda, D Abe, C Ohwada, E Sakaida, N Shimizu, T Iseki & C Nakaseko

  2. Division of Blood Transfusion, Chiba University Hospital, Chiba, Japan

    T Muto, T Kawaguchi, N Shimizu & T Iseki

  3. Department of Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. E-mail: chiaki-nakaseko@faculty.chiba-u.jp,

    K Yokote

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Muto, T., Takeuchi, M., Kawaguchi, T. et al. Low-dose trimethoprim–sulfamethoxazole for Pneumocystis jiroveci pneumonia prophylaxis after allogeneic hematopoietic SCT. Bone Marrow Transplant 46, 1573–1575 (2011). https://doi.org/10.1038/bmt.2010.335

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