Pentamidine for prophylaxis after an allogeneic stem cell transplant – pro
Pneumocystis jiroveci pneumonia (PJP) contributes to significant mortality and morbidity in immunosuppressed patients. Patients who have undergone allogeneic hematopoietic progenitor cell (HPC) transplant are, therefore, highly susceptible to PJP.Pneumocystis carinii pneumonia (PCP) prophylaxis is recommended after hematopoietic stem cell transplantation (HSCT). In patients who are unable to take first-line prophylaxis, trimethoprim/sulfamethoxazole, aerosolized pentamidine is recommended. Trimethoprim/sulfamethoxazole given 2–3 times weekly is the drug of choice for the primary prophylaxis of PCP in adults (A-II) and children (A-I) and should be given during the entire period at risk. Recent data indicate that children may benefit equally from a once-weekly regimen (B-II). All other drugs, including pentamidine, atovaquone and dapsone, are considered second-line alternatives when trimethoprim/sulfamethoxazole is poorly tolerated or contraindicated. The record does not indicate that tripethprim/sulfamethaxole cannot be provided.
J. Maertens et al, ECIL guidelines for preventing Pneumocystis jirovecii pneumonia in patients with hematological malignancies and stem cell transplant recipients. Journal of Antimicrobial Chemotherapy, Volume 71, Issue 9, September 2016, Pages 2397–2404,
Pentamidine Prescribing Information 2022
Diken AI, Diken OE, Hanedan O, et al. Pentamidine in Pneumocystis jirovecii prophylaxis in heart transplant recipients. World J Transplant. 2016; 6(1): 193-198.