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

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

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
2013

abstract No: 

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Full conference title: 

53rd Interscience Conference on Antimicrobial Agents and Chemotherapy
    • ICAAC, 53rd (2013)