Prophylaxis for Pneumocystis pneumonia (PCP) in non‐HIV immunocompromised patients

摘要: Background Pneumocystis pneumonia (PCP) is a disease affecting immunocompromised patients. PCP among these patients associated with significant morbidity and mortality. Objectives To assess the effectiveness of prophylaxis non-HIV patients; to define type patient for whom evidence suggests benefit prophylaxis. Search methods Electronic searches Cochrane Central Register Controlled Trials (CENTRAL) (The Library 2014, Issue 1), MEDLINE EMBASE (to March 2014), LILACS relevant conference proceedings; references identified trials. Selection criteria Randomised controlled trials (RCTs) or quasi-RCTs comparing an antibiotic effective against versus placebo, no intervention, antibiotic(s) activity PCP; different antibiotics We only included in which Pneumocystis infections were available as outcome. Data collection analysis Two review authors independently assessed risk bias each trial extracted data from trials. contacted obtain missing data. The primary outcome was documented infections. Risk ratios (RR) 95% confidence intervals (CI) estimated pooled using random-effects model. Main results Thirteen performed between years 1974 2008 included, involving 1412 Four 520 children acute lymphoblastic leukemia remaining adults leukemia, solid organ transplantation autologous bone marrow transplantation. Compared treatment fluoroquinolones (inactive Pneumocystis), there 85% reduction occurrence receiving trimethoprim/sulfamethoxazole, RR 0.15 (95% CI 0.04 0.62; 10 trials, 1000 patients). graded moderate due possible bias. PCP-related mortality also significantly reduced, 0.17 0.03 0.94; nine 886 patients) (low quality imprecision), but placebo effect on all-cause imprecision). Occurrence leukopenia neutropenia their duration not reported consistently. No differences overall adverse events requiring discontinuation seen trimethoprim/sulfamethoxazole (four 470 patients, evidence). once daily thrice weekly (two 207 patients). Authors' conclusions Given event rate 6.2% control groups highly number needed treat prevent 19 17 42). Prophylaxis should be considered similar baseline PCP.