Outcomes of low-dose trimethoprim-sulfamethoxazole treatment in patients with non-HIV pneumocystis pneumonia: A nationwide Japanese retrospective cohort study - 06/12/24
, Shotaro Aso b, Taisuke Jo a, Hiroki Matsui a, Kiyohide Fushimi c, Hideo Yasunaga aHighlights |
• | The effectiveness of low-dose trimethoprim-sulfamethoxazole for Pneumocystis jirovecii pneumonia in patients without human immunodeficiency virus (HIV) infection has yet to be thoroughly investigated. |
• | Our nationwide Japanese retrospective cohort study showed that low-dose trimethoprim-sulfamethoxazole treatment was not associated with higher in-hospital mortality than conventional-dose treatment. |
• | Low-dose trimethoprim-sulfamethoxazole may be considered as a treatment option for patients with non-HIV Pneumocystis jirovecii pneumonia. |
Abstract |
Objectives |
Low-dose trimethoprim-sulfamethoxazole (TMP-SMX) may be a treatment option for patients with Pneumocystis jirovecii pneumonia (PCP). However, its effectiveness in patients without human immunodeficiency virus (HIV) infection has yet to be thoroughly investigated.
Methods |
This retrospective cohort study used data extracted from the Japanese Diagnosis Procedure Combination inpatient database. We included immunocompromised patients without HIV having been diagnosed with PCP and had started TMP-SMX treatment between July 2010 and March 2022. We divided eligible patients into conventional-dose (15.0–20.0 mg/kg/d) and low-dose (7.5–15.0 mg/kg/d) groups and performed propensity-score overlap-weighting analysis. The primary outcome was in-hospital mortality rate. Secondary outcomes were completion of the initial treatment and use of alternatives to TMP-SMX for PCP treatment during hospitalization.
Results |
Among 4449 eligible patients, 1682 (37.8 %) and 2767 (62.2 %) received conventional- and low-dose TMP-SMX treatments, respectively. No significant difference was observed in in-hospital mortality (risk difference, −1.4 %; 95 % CI, −4.5–1.7 %; P = 0.388). Low-dose TMP-SMX was associated with increased completion of initial treatment (risk difference, 4.6 %; 95 % CI, 2.3–6.9 %; P < 0.001), and reduced use of alternative agents (risk difference, −4.0 %; 95 % CI, −7.4 to −0.6 %; P = 0.020).
Conclusion |
Low-dose TMP-SMX may be a treatment option for patients with non-HIV PCP.
Le texte complet de cet article est disponible en PDF.Keywords : Immunodeficiency, Non-human immune deficiency virus, Pneumocystis jirovecii pneumonia, Treatment outcome, Trimethoprim-sulfamethoxazole
Abbreviations : CI, HIV, ICD-10, PCP, RD, TMP-SMX
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Vol 54 - N° 8
Article 104992- décembre 2024 Retour au numéro
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