Caspofungin as Salvage Treatment in Immunocompromised Patients with Pneumocystis Jiroveci Pneumonia (PCP)

Ref ID: 19264

Author:

A. Ricciardi, G. Maffongelli, A. Di Veroli, B. Mariotti, M. Vincenzo, N. Cesta, M. Viscione, A. Venditti, L. Sarmati, P. Sordillo, M. Andreoni

Author address:

Tor Vergata Univ. Hosp., Rome, ITALY

Full conference title:

53rd Interscience Conference on Antimicrobial Agents and Chemotherapy

Date: 10 September 2014

Abstract:

Background: PCP is a major cause of mortality among immunocompromised persons and in human immunodeficiency virus (HIV) individuals. Trimethoprim-sulfamethoxazole (TMP-SMX) is the drug of choice for treatment of PCP but unfortunately adverse effects and treatment failure are not rare. Alternatives treatments are usually complicated by side effects. Echinocandins showed therapeutic efficacy in PCP in animal models. Limited case studies of successful caspofungin treatment for PCP has been described in HIV patients and in other immunocompromised patients Methods: All the data were retrospectively collected. A total of 12 patients were admitted at Tor Vergata Hospital in Rome (Italy) with diagnosis of PCP. All cases were confirmed by PCR analysis of bronchoalveolar lavage fluid or induced sputum Results: The study included 12 patients, 66% were men (8/12) and the mean age was 49 years (26-75 years). Causes for Immunodeficiency were: HIV (7/12), kidney transplant (1/12), hematological malignancy (3/12), bone marrow transplantation (1/12). A total of 3 patients had been receiving PCP prophylaxis at diagnosis. The PCP was considered moderate/severe in 8 cases. The less severe form was more common in HIV patients (3/7)
than in non-HIV patients (1/5). For 11/12 patients, the
first line treatment was TMP-SMX. Since primaquine was
not available in our hospital and considering the high
burden of pentamidine related toxicities, caspofungin was
used as a first line treatment in 1/12 patients and as
second-line treatment in combination with TMP-SMX on the
grounds of suspected treatment failure in 2/12 cases, in
combination with TMP-SMX and pentamydine in 2/12
patients, used alone, when TMP-SMX was stopped due to
toxicities, in 7/12 cases. The treatment with TMP-SMX was
stopped or caspofungin was added after an interval of 1
week. Average duration of Caspofungin administration was
19,5 days (7-32 days). Overall length of treatment was 24
days (20-36 days). All the patients improved and
recovered from PCP. No hospital in death was reported at
follow-up at 90 days.Conclusions: On the basis of our
experience, caspofungin deserves consideration as
alternative in PCP patients and may be particularly suitable
for the absence of severe side effects and drug-drug
interaction

Abstract Number: NULL

Conference Year: 2013

Link to conference website: NULL

New link: NULL

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