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KMID : 0869620170340030303
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Journal of Korean Society of Hospital Pharmacists
2017 Volume.34 No. 3 p.303 ~ p.312
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A retrospective Comparison of Oral and Intravenous Routes of Trimethoprim-sulfamethoxazole for the Treatment of Pneumocystis Jiroveci Pneumonia in Non-HIV Infected Patients
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Oh Ju-Young
Lee Kyung-A
Kim Jae-Song
Son Eun-Sun
Park Moo-Suk
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Abstract
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Pneumocystis jiroveci pneumonia(PCP), caused by Pneumocystis jiroveci (P. jiroveci), is widespread in immunosuppressed patients. Oral trimethoprim-sulfamethoxazole (TMP-SMX) agents have a high bioavailability and economic benefits, whereas intravenous (IV) agents may result in fluid overload and electrolyte imbalance. Studies on the effectiveness and safety analysis are insufficient, and most studies are subject to human immunodeficiency virus (HIV) infection status. This study compares the effectiveness and safety based on the route of administration of TMP-SMX, in PCP patients without HIV infection.
We retrospectively reviewed 158 patients treated between 2013 and 2015, at the Yonsei University Health system. The therapeutic dose of TMP-SMX was administered for more than 14 days. Efficacy was evaluated by PCP polymerase chain reaction, six-month mortality, conversion rate to 2nd line therapy, ventilator weaning, PaO2/FiO2 ratio, fever and improvement. The safety was evaluated by electrolyte imbalance and fluid imbalance, hematologic side effects, renal, hepatic, and gastrointestinal intolerance, and skin rash occurrence.
In 67(42.4%) cases, patients were administrated by the oral route, and 91(57.6%) patients received IV administration. The six-month mortality was significantly lower in the oral administration group (p 0.05). Also, the serum sodium, blood urea nitrogen and serum aspartate aminotransferase levels were significantly elevated in the IV administration group (p 0.05). No statistically significant differences were seen in other areas of comparison.
In severe cases of PCP, physicians usually administered TMP-SMX through IV. The overall efficacy did not differ among the evaluated subset of patients without HIV infection, who received oral and IV TMP-SMX. In consideration of efficacy, safety and cost, differences in expected categories of safety could guide the clinician in preferentially choosing the oral administration route, particularly for patients with baseline renal or hepatic insufficiency or hyponatremia state. Subsequent large scale follow-up studies are required, to complement the limitations of this study.
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KEYWORD
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Trimethoprim-sulfamethoxazole, PCP, Pneumocystis jiroveci, Administration route
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