Preliminary Study on the Combination Effect of Clindamycin and Low Dose Trimethoprim-Sulfamethoxazole on Severe Pneumocystis Pneumonia After Renal Transplantation

Frontiers in Medicine

article

Zhun-Yong Gu¹  Wen-Jun Liu¹  Dan-Lei Huang¹  Yu-Jing Liu²  Hong-Yu He¹  Cheng Yang³  Yi-Mei Liu¹  Ming Xu³  Rui-Ming Rong³  Du-Ming Zhu¹  Zhe Luo¹  Min-Jie Ju¹ 

[1] Department of Critical Care Medicine, Zhongshan Hospital, Fudan University;Department of Nursing, Zhongshan Hospital, Fudan University;Department of Urology Surgery, Zhongshan Hospital, Fudan University

关键词: clindamycin;    trimethoprim-sulfamethoxazole;    Pneumocystis pneumonia;    renal transplantation;    combination;   

DOI  :  10.3389/fmed.2022.827850

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Objective Evaluate the effect of the combination of clindamycin with low-dose trimethoprim-sulfamethoxazole (TMP/SMX) regimen on sever Pneumocystis pneumonia (PCP) after renal transplantation. Method 20 severe PCP patients after renal transplantation were included in this historical-control, retrospective study. A 10 patients were treated with the standard dose of TMP/SMX (T group), the other 10 patients were treated with the combination of clindamycin and low dose TMP/SMX (CT group). Results Although there was no significant difference in the hospital survival between the two groups, the CT protocol improved the PaO2/FiO2 ratio more significantly and rapidly after the 6th ICU day (1.51 vs. 0.38, P = 0.014). CT protocol also ameliorated the pulmonary infiltration and the lactate dehydrogenase level more effectively. Moreover, the CT protocol reduced the incidence of pneumomediastinum (0 vs. 50%, P = 0.008), the length of hospital staying (26.5 vs. 39.0 days, P = 0.011) and ICU staying (12.5 vs. 22.5 days, P = 0.008). Furthermore, more thrombocytopenia (9/10 vs. 3/10, P = 0.020) was emerged in the T group than in the CT group. The total adverse reaction rate was much lower in the CT group than in the T group (8/80 vs. 27/80, P < 0.001). Consequently, the dosage of TMP/SMX was reduced in 8 patients, while only 2 patients in the CT group received TMP/SMX decrement ( P = 0.023). Conclusion The current study proposed that clindamycin combined with low-dose TMP/SMX was more effective and safer the than single use of TMP/SMX for severe PCP patients after renal transplantation.

【 授权许可】

CC BY