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Clindamycin–primaquine for pneumocystis jiroveci pneumonia in renal transplant patients

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Abstract

Background

Trimethoprim/sulfamethoxazole (TMP/SMX) is considered first-line therapy for pneumocystis jiroveci pneumonia (PCP) in renal transplant patients. Alternatives have not been formally studied. Clindamycin–primaquine (C–P) is effective in HIV-associated PCP, but data in renal transplant patients are lacking.

Patients and methods

Retrospective cohort study of 57 consecutive renal transplant patients who developed PCP and were treated with C–P (n = 23) or TMP/SMX (n = 34).

Results

A non-significantly higher failure rate was observed in patients on C–P due to lack of efficacy (30.4 versus 20.6 %, p = 0.545). The difference was more pronounced in severe PCP (60 versus 37.5 %, p = 0.611) and a significantly lower efficacy of C–P was seen when used as salvage therapy. The two patients who had received C–P after not responding to TMP/SMX failed this regimen, but all seven patients who had failed initial treatment with C–P and had been switched to TMP/SMX were cured (p = 0.028). No treatment-limiting adverse reactions were reported for patients on C–P while six patients (17.6 %) on TMP/SMX developed possibly related treatment-limiting toxicity (p = 0.071). However, in only two patients adverse events were definitely related to TMP/SMX (5.9 %).

Conclusions

Clindamycin–primaquine appears to be safe and well tolerated for treating PCP in renal transplant patients but is probably less effective than TMP/SMX, the standard regimen. However, our data indicates that C–P represents an acceptable alternative for patients with contraindications or treatment emergent toxicities during TMP/SMX use. Notably, TMP/SMX was also acceptably tolerated in most patients. TMP/SMX remains an effective salvage regimen in case of C–P failure.

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Authors and Affiliations

  1. Division of Nephrology and Intensive Care, Department of Internal Medicine, Campus Virchow-Klinikum, Charité-University Medicine Berlin, Berlin, Germany

    P. Nickel, R. Schindler & P. Reinke

  2. Division of Infectious Diseases and Pulmonary Medicine, Department of Internal Medicine, Campus Virchow-Klinikum, Charité-University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    M. Schürmann, N. Suttorp & D. Schürmann

  3. Division of Infectious Diseases, Department of Internal Medicine, University of South Carolina, Columbia, USA

    H. Albrecht

  4. Division of Nephrology, Department of Internal Medicine, Campus Charité Mitte, Charité-University Medicine Berlin, Berlin, Germany

    K. Budde

  5. Division of Nephrology, Department of Internal Medicine, Charité-Campus Benjamin Franklin, University Medicine Berlin, Berlin, Germany

    T. Westhoff

  6. Institute of Medical Immunology, Charité-University Medicine Berlin, Berlin, Germany

    J. Millward

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  1. P. Nickel
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  2. M. Schürmann
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  3. H. Albrecht
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  4. R. Schindler
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  8. N. Suttorp
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  10. D. Schürmann
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Correspondence to D. Schürmann.

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Petra Reinke and Dirk Schürmann are joint senior members.

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Nickel, P., Schürmann, M., Albrecht, H. et al. Clindamycin–primaquine for pneumocystis jiroveci pneumonia in renal transplant patients. Infection 42, 981–989 (2014). https://doi.org/10.1007/s15010-014-0660-y

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  • DOI: https://doi.org/10.1007/s15010-014-0660-y

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