인간면역결핍바이러스 비감염자에서 발생한 주폐포자충 폐렴 환자군에서 trimethoprim-sulfamethoxazole의 투여 경로에 따른 효과 및 안전성 분석
A retrospective Comparison of Oral and Intravenous Routes of Trimethoprim-sulfamethoxazole for the Treatment of Pneumocystis Jiroveci Pneumonia in Non-HIV Infected Patients
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
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 tcost, differences in expected categories of safety could guide the clinician in preferentially choosing the oral administration route, particularly for patients with baseline renal or he 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 hepatic insufficiency or hyponatremia state. Subsequent large scale follow-up studies are required, to complement the limitations of this study.
Abstract
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 tcost, differences in expected categories of safety could guide the clinician in preferentially choosing the oral administration route, particularly for patients with baseline renal or he 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 hepatic insufficiency or hyponatremia state. Subsequent large scale follow-up studies are required, to complement the limitations of this study.
참고문헌 (23)
- Thomas CF, Jr, "Pneumocystis pneumonia", N Engl J Med, 350(24), pp.2487~2498 (2004)
- Phair J, "The risk of Pneumocystis carinii pneumonia among men infected with human immunodeficiency virus type 1", N Engl J Med, 322(3), pp.161~165 (1990), Multicenter AIDS Cohort Study Group
- Kales CP, "Early predictors of in-hospital mortality for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome", Arch Intern Med, 147(8), pp.1413~1417 (1987)
- Masur H, "Guidelines for preventing opportunistic infections among HIV-infected persons--2002. Recommendations of the U.S. Public Health Service and the Infectious Diseases Society of America", Ann Intern Med, 137(5 Pt 2), pp.435~478 (2002)
- Roux A, "Update on pulmonary Pneumocystis jirovecii infection in non-HIV patients", Med Mal Infect, 44(5), pp.185~198 (2014)
- Crans CA, Jr, "Imaging features of Pneumocystis carinii pneumonia", Crit Rev Diagn Imaging, 40(4), pp.251~284 (1999)
- Azoulay E, "Diagnostic strategy in cancer patients with acute respiratory failure", Intensive Care Med, 32(6), pp.808~822 (2006)
- Azoulay E, "Polymerase chain reaction for diagnosing pneumocystis pneumonia in non-HIV immunocompromised patients with pulmonary infiltrates", Chest, 135(3), pp.655~661 (2009)
- Huang L, "An Official ATS Workshop Summary : Recent advances and future directions in pneumocystis pneumonia(PCP)", Proc Am Thorac Soc, 3(8), pp.655~664 (2006)
- Castro JG, "Management of Pneumocystis Jirovecii pneumonia in HIV infected patients : current options, challenges and future directions", HIV AIDS(Auckl), 2, pp.123~134 (2010)
- Limper AH, "An official American Thoracic Society statement : Treatment of fungal infections in adult pulmonary and critical care patients", Am J Respir Crit Care Med, 183(1), pp.96~128 (2011)
- Smilack JD, "Trimethoprim-sulfamethoxazole", Mayo Clin Proc, 74(7), pp.730~734 (1999)
- Gleckman R, "Intravenous sulfamethoxazole-trimethoprim : pharmacokinetics, therapeutic indications, and adverse reactions", Pharmacotherapy, 1(3), pp.206~211 (1981)
- Mikaelsson L, "Pneumocystis pneumonia--a retrospective study 1991-2001 in Gothenburg, Sweden", J Infect, 53(4), pp.260~265 (2006)
- Nuesch R, "Pneumocystis carinii pneumonia in human immunodeficiency virus(HIV)-positive and HIV-negative immunocompromised patients", Clin Infect Dis, 29(6), pp.1519~1523 (1999)
- Mansharamani NG, "Management and outcome patterns for adult Pneumocystis carinii pneumonia, 1985 to 1995 : comparison of HIVassociated cases to other immunocompromised states", Chest, 118(3), pp.704~711 (2000)
- Muhlethaler K, "Quantitative PCR to diagnose Pneumocystis pneumonia in immunocompromised non-HIV patients", Eur Respir J, 39(4), pp.971~978 (2012)
- Festic E, "Acute respiratory failure due to pneumocystis pneumonia in patients without human immunodeficiency virus infection : outcome and associated features", Chest, 128(2), pp.573~579 (2005)
- Sing A, "Evaluation of diagnostic value and epidemiological implications of PCR for Pneumocystis carinii in different immunosuppressed and immunocompetent patient groups", J Clin Microbiol, 38(4), pp.1461~1467 (2000)
- Yale SH, "Pneumocystis carinii pneumonia in patients without acquired immunodeficiency syndrome : associated illness and prior corticosteroid therapy", Mayo Clin Proc, 71(1), pp.5~13 (1996)
- Sepkowitz KA, "Opportunistic infections in patients with and patients without Acquired Immunodeficiency Syndrome", Clin Infect Dis, 34(8), pp.1098~1107 (2002)
- Moon SM, "Outcomes of moderate-to-severe Pneumocystis pneumonia treated with adjunctive steroid in non-HIV-infected patients", Antimicrob Agents Chemother, 55(10), pp.4613~4618 (2011)
- Roembke F, "Clinical outcome and predictors of survival in patients with pneumocystis jirovecii pneumonia--results of a tertiary referral centre", Clin Respir J, 8(1), pp.86~92 (2014)