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.
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Article Info
Footnotes
This article is based on a Cochrane Review published in The Cochrane Library 2007 (see end of article for more details).
Identification
Copyright
© 2007 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
