A retrospective study of intravenous pentamidine for Pneumocystis jirovecii pneumonia prophylaxis in adult patients with hematologic malignancies—its utility during respiratory virus pandemics

• Published in: International journal of infectious diseases Vol. 143; p. 107059
• Main Authors: Liew, Yi Xin, Ho, Aloysius Yew Leng, Wong, Gee Chuan, Chung, Shimin Jasmine, Tan, Thuan Tong, Tan, Ban Hock
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.06.2024; Elsevier
• Subjects: PCP prophylaxis; Pentamidine; Pentamidine; PCP prophylaxis
• DOI: 10.1016/j.ijid.2024.107059
• ISSN: 1201-9712

•In hematology, Pneumocystis jirovecii pneumonia prophylaxis is recommended for selected patients.•Intravenous pentamidine is a potential alternative agent.•A total of 202 unique patients received 239 courses of intravenous pentamidine 4 mg/kg (maximum 300 mg).•There was no breakthrough P. jirovecii pneumonia infection or adverse effects. In hematology, prophylaxis for Pneumocystis jirovecii pneumonia (PCP) is recommended for patients undergoing hematopoietic stem cell transplantation and in selected categories of intensive chemotherapy for hematologic malignancies. Trimethoprim-sulfamethoxazole (TMP-SMX) is the recommended first-line agent; however, its use is not straightforward. Inhaled pentamidine is the recommended second-line agent; however, aerosolized medications were discouraged during respiratory virus outbreaks, especially during the COVID-19 pandemic, in view of potential contamination risks. Intravenous (IV) pentamidine is a potential alternative agent. We evaluated the effectiveness and tolerability of IV pentamidine use for PCP prophylaxis in adult allogeneic hematopoietic stem cell transplantation recipients and patients with hematologic malignancies during COVID-19. A total of 202 unique patients who received 239 courses of IV pentamidine, with a median of three doses received (1-29). The largest group of the patients (49.5%) who received IV pentamidine were undergoing or had received a hematopoietic stem cell transplant. The most common reason for not using TMP-SMX prophylaxis was cytopenia (34.7%). We have no patients who had breakthrough PCP infection while on IV pentamidine. None of the patients developed an infusion reaction or experienced adverse effects from IV pentamidine. Pentamidine administered IV monthly is safe and effective.