Published online June 4, 2007
PEDIATRICS Vol. 120 No. 1 July 2007, pp. e47-e51 (doi:10.1542/peds.2006-1360)
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ARTICLE

Successful Intermittent Prophylaxis With Trimethoprim/Sulfamethoxazole 2 Days per Week for Pneumocystis carinii (jiroveci) Pneumonia in Pediatric Oncology Patients

Susan Lindemulder, MD and Edythe Albano, MD

Center for Cancer and Blood Disorders, University of Colorado Health Science Center, Children's Hospital, Denver, Colorado

OBJECTIVE. This study was conducted to determine the efficacy of dosing trimethoprim/sulfamethoxazole on 2 consecutive days per week for the prevention of Pneumocystis carinii (jiroveci) pneumonia in a pediatric leukemia and lymphoma population and to determine whether trimethoprim/sulfamethoxazole contributes to neutropenia during maintenance therapy.

METHODS. Charts were reviewed for all pediatric patients with leukemia and lymphoma diagnosed between January 1, 1993, and December 31, 2002. Data were collected through April 1, 2004.

RESULTS. A total of 575 charts were reviewed; 529 patients were included in the analysis. A total of 482 (345 leukemia, 137 lymphoma) patients were evaluated on trimethoprim/sulfamethoxazole dosed 2 consecutive days per week for 268074 patient-days. No breakthrough cases were documented in compliant patients; 2 noncompliant patients developed P carinii pneumonia. A total of 238 patients who were on trimethoprim/sulfamethoxazole prophylaxis and 13 patients who were receiving an alternative medication prophylaxis were evaluated for neutropenia during maintenance therapy. The median number of maintenance days on trimethoprim/sulfamethoxazole was 605.5 days and on alternative drug was 617 days. The median number of neutropenic maintenance days on trimethoprim/sulfamethoxazole was 15.5 days and on the alternative drug was 16 days. The median proportion of neutropenic days per patient was 0.029 on trimethoprim/sulfamethoxazole and 0.022 on the alternative drug.

CONCLUSIONS. Intermittent dosing of trimethoprim/sulfamethoxazole on 2 consecutive days per week is an effective alternative prophylactic regimen for P carinii pneumonia in pediatric patients with leukemia and lymphoma. This analysis does not support a difference in neutropenia during maintenance therapy between patients who are treated with trimethoprim/sulfamethoxazole versus an alternative drug.

Key Words: Pneumocystis carinii (jiroveci) • chemoprophylaxis • trimethoprim/sulfamethoxazole • leukemia • lymphoma • pediatrics

Abbreviations: PCP—Pneumocystis carinii pneumonia • TMP/SMX—trimethoprim/sulfamethoxazole • ALL—acute lymphoblastic leukemia

Accepted Dec 12, 2006.


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