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Title: Taking the challenge: A protocolized approach to optimize Pneumocystis pneumonia prophylaxis in renal transplant recipients.
Austin Authors: Urbancic, Karen F ;Ierino, Francesco L;Phillips, E;Mount, Peter F ;Mahony, Andrew A ;Trubiano, Jason 
Affiliation: Pharmacy
National Centre for Infections in Cancer, National Health and Medical Research Council Centre of Research Excellence, Peter MacCallum Cancer Centre, Department of Oncology, University of Melbourne, Parkville, VIC, Australia
Department of Medicine, University of Melbourne, Parkville, VIC, Australia
Nephrology Department, St Vincent's Hospital, Melbourne, VIC, Australia
Infectious Diseases
Infectious Diseases Department, Vanderbilt University Medical Center, Nashville, TN, USA
Issue Date: Feb-2018
Date: 2017-10-03
Publication information: American Journal of Transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons 2018; 18(2): 462-466
Abstract: While trimethoprim-sulfamethoxazole is considered first-line therapy for Pneumocystis pneumonia prevention in renal transplant recipients, reported adverse drug reactions may limit use and increase reliance on costly and less effective alternatives, often aerosolized pentamidine. We report our experience implementing a protocolized approach to trimethoprim-sulfamethoxazole adverse drug reaction assessment and rechallenge to optimize prophylaxis in this patient cohort. We retrospectively reviewed 119 patients receiving Pneumocystis pneumonia prophylaxis prior to and after protocol implementation. Forty-two patients (35%) had 48 trimethoprim-sulfamethoxazole adverse drug reactions documented either at baseline or during the prophylaxis period, of which 83% were non-immune-mediated and 17% were immune-mediated. Significantly more patients underwent trimethoprim-sulfamethoxazole rechallenge after protocol implementation (4/22 vs 23/27; P = .0001), with no recurrence of adverse drug reactions in 74%. In those who experienced a new or recurrent reaction (26%), all were mild and self-limiting with only 1 recurrence of an immune-mediated reaction. After protocol implementation, aerosolized pentamidine-associated costs were reduced. The introduction of a standard approach to trimethoprim-sulfamethoxazole rechallenge in the context of both prior immune and non-immune-mediated reactions was safe and successful in improving the uptake of first-line Pneumocystis pneumonia prophylaxis in renal transplant recipients.
DOI: 10.1111/ajt.14498
ORCID: 0000-0002-9275-578X
Journal: American Journal of Transplantation
PubMed URL: 28898546
Type: Journal Article
Subjects: allergy
antibiotic prophylaxis
clinical research/practice
drug toxicity
infectious disease
kidney transplantation/nephrology
kidney transplantation: living donor
Appears in Collections:Journal articles

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