Atovaquone for Prophylaxis of Toxoplasmosis after Allogeneic Hematopoietic Stem Cell Transplantation
| Autor: | Tatjana Zabelina, Marc Regier, Adelbert Bacher, Alexander Mendorf, Ulrike Bacher, Christine Wolschke, Evgeny Klyuchnikov, Maximilian Christopeit, Claudia Langebrake, Francis Ayuk, Nicolaus Kröger, Holger Rohde, Thomas Stübig |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent medicine.medical_treatment Hematopoietic stem cell transplantation urologic and male genital diseases Young Adult Anti-Infective Agents Internal medicine Trimethoprim Sulfamethoxazole Drug Combination medicine Humans Transplantation Homologous Pneumocystis jirovecii Atovaquone Aged Retrospective Studies Brain Diseases biology business.industry Sulfamethoxazole Hematopoietic Stem Cell Transplantation Hematology General Medicine Middle Aged bacterial infections and mycoses medicine.disease biology.organism_classification Hematologic Diseases Magnetic Resonance Imaging Trimethoprim female genital diseases and pregnancy complications Toxoplasmosis Transplantation Immunology Female business Pentamidine medicine.drug |
| Zdroj: | Acta Haematologica. 134:146-154 |
| ISSN: | 1421-9662 0001-5792 |
| Popis: | Toxoplasmosis and infections by other opportunistic agents such as Pneumocystis jirovecii constitute life-threatening risks for patients after allogeneic hematopoietic stem cell transplantation. Trimethoprim/sulfamethoxazole (TMP-SMX) has been well established for post-transplant toxoplasmosis and pneumocystis prophylaxis, but treatment may be limited due to toxicity. We explored atovaquone as an alternative and compared it with TMP-SMX regarding toxicity and efficacy during the first 100 days after transplantation in 155 consecutive adult stem cell recipients. Eight patients with a prior history of TMP-SMX intolerance received atovaquone as first-line prophylaxis. TMP-SMX was used for 141 patients as first-line strategy, but 13 patients (9.2%) were later switched to atovaquone due to TMP-SMX toxicity or gastrointestinal symptoms. No active toxoplasmosis or active P. jirovecii infection developed under continued prophylaxis with either TMP-SMX or atovaquone. However, for reasons of TMP-SMX and/or atovaquone toxicity, 7 patients were unable to tolerate any efficacious toxoplasmosis prophylaxis and therefore obtained inhalative pentamidine as P. jirovecii prophylaxis but no toxoplasmosis prophylaxis. Importantly, 2 of these patients developed severe toxoplasmosis. In summary, atovaquone appears as a valid alternative for at least some post-transplant patients who cannot tolerate TMP-SMX. This should be further confirmed by multicenter trials. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|