The regimen based on trimethoprim/sulfamethoxazole combination of caspofungin and corticosteroids as the first-line therapy for non-HIV patients with severe pneumocystis jirovecii pneumonia：a retrospective research of a tertiary hospital

Abstract

Abstract Background: Pneumocystis jirovecii pneumonia (PJP) is a life-threatening and severe disease in immunocompromised hosts. The synergic regimen based on sulfamethoxazole-trimethoprim (SMX-TMP) combination of caspofungin and glucocorticosteroid (GCS) may be a potential first-line therapy. Therefore, it is important to explore the efficacy and safety of this synergic therapy to treat non-HIV PJP patient. Methods: We retrospectively analyzed the data of 38 patients with non-HIV PJP at the the First Affiliated Hospital of Xi’an Jiaotong University. Patients were divided into two groups: synergic therapy group (ST group, n=20) and monotherapy group (MT group, n=18). All patients were from ICU and defined as severe PJP. In ST group, all patients were treated by SMX-TMP (TMP 15-20 mg/kg per day) combined with caspofungin (70 mg as loading dose then 50 mg/day as maintenance dose) and GCS (methylprednisolone 40-80 mg/day). Patients in MT group were only treated by TMP-SMX (TMP 15-20 mg/kg per day). The clinical response, adverse events and mortality were compared between these two groups. Results: The positive clinical response in ST group was significant higher than that in MT group, which was 100.00% vs 66.70% (P=0.005). The incidence of adverse events in MT group was higher than that in ST group, which was 50.00% vs 15.00% (P=0.022). Furthermore, the dose of TMP and duration of fever in ST group were remarkably lower than that in MT group, which were 15.71 mg/kg/day vs 18.35 mg/kg/day (P=0.001) and 7.00 days vs 11.50 days (P=0.029), respectively. However, there was no significant differences in all-cause mortality and duration of hospital stay between MT group and ST group. Conclusions: In comparison with SMZ/TMP monotherapy, the synergic therapy (SMZ-TMP combination of caspofungin and GCS) to treatment non-HIV PJP can increase the positive clinical response rate and decrease the incidence of adverse events and shorten the duration of fever. These results indicated that the synergic therapy was efficacy and safety to treatment severe non-HIV PJP.