Prophylaxis of Pneumocystis Pneumonia in Immunocompromised Non-HIV-Infected Patients: Systematic Review and Meta-analysis of Randomized Controlled Trials
OBJECTIVE To assess the efficacy of prophylaxis for Pneumocystis pneumonia (PCP), caused by Pneumocystis jirovecii (formerly Pneumocystis carinii ), for immunocompromised non-HIV-infected patients by conducting a systematic review and meta-analysis. METHODS We searched for randomized controlled tria...
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description | OBJECTIVE To assess the efficacy of prophylaxis for Pneumocystis pneumonia (PCP), caused by Pneumocystis jirovecii (formerly Pneumocystis carinii ), for immunocompromised non-HIV-infected patients by conducting a systematic review and meta-analysis. METHODS We searched for randomized controlled trials that compared prophylaxis using antibiotics effective against P jirovecii , given orally or intravenously, vs placebo, no intervention, or antibiotics with no activity against P jirovecii. In addition, we included trials that compared different PCP prophylactic regimens or administration schedules. The search included the Cochrane Central Register of Controlled Trials, PubMed, Latin American and Caribbean Health Sciences Literature, and conference proceedings. No language, year, or publication restrictions were applied. Two reviewers (H.G. and M.P.) independently searched, selected trials, extracted data, and performed methodological quality assessment. Relative risks (RRs) with 95% confidence intervals (CIs) are reported. Meta-analysis was performed using the random-effects model. RESULTS Twelve randomized trials were identified, including 1245 patients (50% children) who had undergone autologous bone marrow or solid organ transplant or who had hematologic cancer. When trimethoprim-sulfamethoxazole was administered, a 91% reduction was observed in the occurrence of PCP (RR, 0.09; 95% CI, 0.02-0.32); the number needed to treat was 15 (95% CI, 13-20) patients, with no heterogeneity. Pneumocystis pneumonia-related mortality was significantly reduced (RR, 0.17; 95% CI, 0.03-0.94), whereas all-cause mortality did not differ significantly (RR, 0.79; 95% CI, 0.18-3.46). Adverse events that required discontinuation occurred in 3.1% of adults and none of the children, and all were reversible. No differences between once-daily and thrice-weekly administration schedules were found. CONCLUSIONS Balanced against severe adverse events, PCP prophylaxis is warranted when the risk for PCP is higher than 3.5% for adults. Adverse events are less frequent in children, for whom prophylaxis might be warranted at lower PCP incidence rates. |
doi_str_mv | 10.4065/82.9.1052 |
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METHODS We searched for randomized controlled trials that compared prophylaxis using antibiotics effective against P jirovecii , given orally or intravenously, vs placebo, no intervention, or antibiotics with no activity against P jirovecii. In addition, we included trials that compared different PCP prophylactic regimens or administration schedules. The search included the Cochrane Central Register of Controlled Trials, PubMed, Latin American and Caribbean Health Sciences Literature, and conference proceedings. No language, year, or publication restrictions were applied. Two reviewers (H.G. and M.P.) independently searched, selected trials, extracted data, and performed methodological quality assessment. Relative risks (RRs) with 95% confidence intervals (CIs) are reported. Meta-analysis was performed using the random-effects model. RESULTS Twelve randomized trials were identified, including 1245 patients (50% children) who had undergone autologous bone marrow or solid organ transplant or who had hematologic cancer. When trimethoprim-sulfamethoxazole was administered, a 91% reduction was observed in the occurrence of PCP (RR, 0.09; 95% CI, 0.02-0.32); the number needed to treat was 15 (95% CI, 13-20) patients, with no heterogeneity. Pneumocystis pneumonia-related mortality was significantly reduced (RR, 0.17; 95% CI, 0.03-0.94), whereas all-cause mortality did not differ significantly (RR, 0.79; 95% CI, 0.18-3.46). Adverse events that required discontinuation occurred in 3.1% of adults and none of the children, and all were reversible. No differences between once-daily and thrice-weekly administration schedules were found. CONCLUSIONS Balanced against severe adverse events, PCP prophylaxis is warranted when the risk for PCP is higher than 3.5% for adults. Adverse events are less frequent in children, for whom prophylaxis might be warranted at lower PCP incidence rates.</description><identifier>ISSN: 0025-6196</identifier><identifier>EISSN: 1942-5546</identifier><identifier>DOI: 10.4065/82.9.1052</identifier><identifier>PMID: 17803871</identifier><identifier>CODEN: MACPAJ</identifier><language>eng</language><publisher>Rochester, MN: Elsevier Inc</publisher><subject>Anti-Infective Agents - administration & dosage ; Anti-Infective Agents - therapeutic use ; Antibiotic Prophylaxis ; Biological and medical sciences ; Care and treatment ; General aspects ; Humans ; Immunocompromised Host ; Internal Medicine ; Medical sciences ; Pneumocystis carinii ; Pneumocystis carinii pneumonia ; Pneumonia, Pneumocystis - mortality ; Pneumonia, Pneumocystis - prevention & control ; Prevention ; Prevention and actions ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Randomized Controlled Trials as Topic ; Treatment Outcome ; Trimethoprim, Sulfamethoxazole Drug Combination - administration & dosage ; Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use</subject><ispartof>Mayo Clinic proceedings, 2007-09, Vol.82 (9), p.1052-1059</ispartof><rights>Mayo Foundation for Medical Education and Research</rights><rights>2007 Mayo Foundation for Medical Education and Research</rights><rights>2007 INIST-CNRS</rights><rights>COPYRIGHT 2007 Elsevier, Inc.</rights><rights>Copyright Mayo Foundation for Medical Education and Research Sep 2007</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c575t-18a7ac066b814f78bb680fe3b62589371a68fa9b0602d12d764a220163f038ff3</citedby><cites>FETCH-LOGICAL-c575t-18a7ac066b814f78bb680fe3b62589371a68fa9b0602d12d764a220163f038ff3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/216872858?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=19088266$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17803871$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Green, Hefziba, MD</creatorcontrib><creatorcontrib>Paul, Mical, MD</creatorcontrib><creatorcontrib>Vidal, Liat, MD</creatorcontrib><creatorcontrib>Leibovici, Leonard, MD</creatorcontrib><title>Prophylaxis of Pneumocystis Pneumonia in Immunocompromised Non-HIV-Infected Patients: Systematic Review and Meta-analysis of Randomized Controlled Trials</title><title>Mayo Clinic proceedings</title><addtitle>Mayo Clin Proc</addtitle><description>OBJECTIVE To assess the efficacy of prophylaxis for Pneumocystis pneumonia (PCP), caused by Pneumocystis jirovecii (formerly Pneumocystis carinii ), for immunocompromised non-HIV-infected patients by conducting a systematic review and meta-analysis. METHODS We searched for randomized controlled trials that compared prophylaxis using antibiotics effective against P jirovecii , given orally or intravenously, vs placebo, no intervention, or antibiotics with no activity against P jirovecii. In addition, we included trials that compared different PCP prophylactic regimens or administration schedules. The search included the Cochrane Central Register of Controlled Trials, PubMed, Latin American and Caribbean Health Sciences Literature, and conference proceedings. No language, year, or publication restrictions were applied. Two reviewers (H.G. and M.P.) independently searched, selected trials, extracted data, and performed methodological quality assessment. Relative risks (RRs) with 95% confidence intervals (CIs) are reported. Meta-analysis was performed using the random-effects model. RESULTS Twelve randomized trials were identified, including 1245 patients (50% children) who had undergone autologous bone marrow or solid organ transplant or who had hematologic cancer. When trimethoprim-sulfamethoxazole was administered, a 91% reduction was observed in the occurrence of PCP (RR, 0.09; 95% CI, 0.02-0.32); the number needed to treat was 15 (95% CI, 13-20) patients, with no heterogeneity. Pneumocystis pneumonia-related mortality was significantly reduced (RR, 0.17; 95% CI, 0.03-0.94), whereas all-cause mortality did not differ significantly (RR, 0.79; 95% CI, 0.18-3.46). Adverse events that required discontinuation occurred in 3.1% of adults and none of the children, and all were reversible. No differences between once-daily and thrice-weekly administration schedules were found. CONCLUSIONS Balanced against severe adverse events, PCP prophylaxis is warranted when the risk for PCP is higher than 3.5% for adults. Adverse events are less frequent in children, for whom prophylaxis might be warranted at lower PCP incidence rates.</description><subject>Anti-Infective Agents - administration & dosage</subject><subject>Anti-Infective Agents - therapeutic use</subject><subject>Antibiotic Prophylaxis</subject><subject>Biological and medical sciences</subject><subject>Care and treatment</subject><subject>General aspects</subject><subject>Humans</subject><subject>Immunocompromised Host</subject><subject>Internal Medicine</subject><subject>Medical sciences</subject><subject>Pneumocystis carinii</subject><subject>Pneumocystis carinii pneumonia</subject><subject>Pneumonia, Pneumocystis - mortality</subject><subject>Pneumonia, Pneumocystis - prevention & control</subject><subject>Prevention</subject><subject>Prevention and actions</subject><subject>Public health. Hygiene</subject><subject>Public health. 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Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Treatment Outcome</topic><topic>Trimethoprim, Sulfamethoxazole Drug Combination - administration & dosage</topic><topic>Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Green, Hefziba, MD</creatorcontrib><creatorcontrib>Paul, Mical, MD</creatorcontrib><creatorcontrib>Vidal, Liat, MD</creatorcontrib><creatorcontrib>Leibovici, Leonard, MD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>University Readers</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>eLibrary</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><jtitle>Mayo Clinic proceedings</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Green, Hefziba, MD</au><au>Paul, Mical, MD</au><au>Vidal, Liat, MD</au><au>Leibovici, Leonard, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prophylaxis of Pneumocystis Pneumonia in Immunocompromised Non-HIV-Infected Patients: Systematic Review and Meta-analysis of Randomized Controlled Trials</atitle><jtitle>Mayo Clinic proceedings</jtitle><addtitle>Mayo Clin Proc</addtitle><date>2007-09-01</date><risdate>2007</risdate><volume>82</volume><issue>9</issue><spage>1052</spage><epage>1059</epage><pages>1052-1059</pages><issn>0025-6196</issn><eissn>1942-5546</eissn><coden>MACPAJ</coden><abstract>OBJECTIVE To assess the efficacy of prophylaxis for Pneumocystis pneumonia (PCP), caused by Pneumocystis jirovecii (formerly Pneumocystis carinii ), for immunocompromised non-HIV-infected patients by conducting a systematic review and meta-analysis. METHODS We searched for randomized controlled trials that compared prophylaxis using antibiotics effective against P jirovecii , given orally or intravenously, vs placebo, no intervention, or antibiotics with no activity against P jirovecii. In addition, we included trials that compared different PCP prophylactic regimens or administration schedules. The search included the Cochrane Central Register of Controlled Trials, PubMed, Latin American and Caribbean Health Sciences Literature, and conference proceedings. No language, year, or publication restrictions were applied. Two reviewers (H.G. and M.P.) independently searched, selected trials, extracted data, and performed methodological quality assessment. Relative risks (RRs) with 95% confidence intervals (CIs) are reported. Meta-analysis was performed using the random-effects model. RESULTS Twelve randomized trials were identified, including 1245 patients (50% children) who had undergone autologous bone marrow or solid organ transplant or who had hematologic cancer. When trimethoprim-sulfamethoxazole was administered, a 91% reduction was observed in the occurrence of PCP (RR, 0.09; 95% CI, 0.02-0.32); the number needed to treat was 15 (95% CI, 13-20) patients, with no heterogeneity. Pneumocystis pneumonia-related mortality was significantly reduced (RR, 0.17; 95% CI, 0.03-0.94), whereas all-cause mortality did not differ significantly (RR, 0.79; 95% CI, 0.18-3.46). Adverse events that required discontinuation occurred in 3.1% of adults and none of the children, and all were reversible. No differences between once-daily and thrice-weekly administration schedules were found. CONCLUSIONS Balanced against severe adverse events, PCP prophylaxis is warranted when the risk for PCP is higher than 3.5% for adults. Adverse events are less frequent in children, for whom prophylaxis might be warranted at lower PCP incidence rates.</abstract><cop>Rochester, MN</cop><pub>Elsevier Inc</pub><pmid>17803871</pmid><doi>10.4065/82.9.1052</doi><tpages>8</tpages></addata></record> |
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subjects | Anti-Infective Agents - administration & dosage Anti-Infective Agents - therapeutic use Antibiotic Prophylaxis Biological and medical sciences Care and treatment General aspects Humans Immunocompromised Host Internal Medicine Medical sciences Pneumocystis carinii Pneumocystis carinii pneumonia Pneumonia, Pneumocystis - mortality Pneumonia, Pneumocystis - prevention & control Prevention Prevention and actions Public health. Hygiene Public health. Hygiene-occupational medicine Randomized Controlled Trials as Topic Treatment Outcome Trimethoprim, Sulfamethoxazole Drug Combination - administration & dosage Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use |
title | Prophylaxis of Pneumocystis Pneumonia in Immunocompromised Non-HIV-Infected Patients: Systematic Review and Meta-analysis of Randomized Controlled Trials |
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