Chemoprophylaxis for Pneumocystis carinii pneumonitis: outcome of unstructured delivery
R. B. Wilber, S. Feldman, W. J. Malone, M. Ryan, R. J. Aur and W. T. Hughes
Sulfamethoxazole-trimethoprim was administered prophylactically to 786
patients judged to be at sufficient risk for development of Pneumocystis
carinii pneumonitis. The selection of patients, administration of the
agents, and surveillance for compliance were the responsibility of the
attending oncologists rather than specialists in infectious diseases, as in
an earlier trial at this center. The recommended dosage was trimethoprim,
150 mg/sq m/day, and sulfamethoxazole, 750 mg/sq m/day. Over a three-year
study period, nine cases of P carinii pneumonitis occurred at this
institution, with none attributable to drug failure. Adverse reactions,
skin rashes mainly, were noted in 43 patients, and one patient died with
Stevens-Johnson syndrome. These results confirm the efficacy of
sulfamethoxazole-trimethoprim in preventing P carinii pneumonitis in
childhood cancer patients and illustrate the feasibility of large-scale
unstructured delivery of the combination to patients with malignant
diseases frequently associated with this pneumonia.
