AUTHOR=Gu Zhun-Yong , Liu Wen-Jun , Huang Dan-Lei , Liu Yu-Jing , He Hong-Yu , Yang Cheng , Liu Yi-Mei , Xu Ming , Rong Rui-Ming , Zhu Du-Ming , Luo Zhe , Ju Min-Jie 

TITLE=Preliminary Study on the Combination Effect of Clindamycin and Low Dose Trimethoprim-Sulfamethoxazole on Severe Pneumocystis Pneumonia After Renal Transplantation

JOURNAL=Frontiers in Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.827850

DOI=10.3389/fmed.2022.827850

ISSN=2296-858X

ABSTRACT=<sec><title>Objective</title><p>Evaluate the effect of the combination of clindamycin with low-dose trimethoprim-sulfamethoxazole (TMP/SMX) regimen on sever <italic>Pneumocystis</italic> pneumonia (PCP) after renal transplantation.</p></sec><sec><title>Method</title><p>20 severe PCP patients after renal transplantation were included in this historical-control, retrospective study. A 10 patients were treated with the standard dose of TMP/SMX (T group), the other 10 patients were treated with the combination of clindamycin and low dose TMP/SMX (CT group).</p></sec><sec><title>Results</title><p>Although there was no significant difference in the hospital survival between the two groups, the CT protocol improved the PaO2/FiO2 ratio more significantly and rapidly after the 6th ICU day (1.51 vs. 0.38, <italic>P</italic> = 0.014). CT protocol also ameliorated the pulmonary infiltration and the lactate dehydrogenase level more effectively. Moreover, the CT protocol reduced the incidence of pneumomediastinum (0 vs. 50%, <italic>P</italic> = 0.008), the length of hospital staying (26.5 vs. 39.0 days, <italic>P</italic> = 0.011) and ICU staying (12.5 vs. 22.5 days, <italic>P</italic> = 0.008). Furthermore, more thrombocytopenia (9/10 vs. 3/10, <italic>P</italic> = 0.020) was emerged in the T group than in the CT group. The total adverse reaction rate was much lower in the CT group than in the T group (8/80 vs. 27/80, <italic>P</italic> &lt; 0.001). Consequently, the dosage of TMP/SMX was reduced in 8 patients, while only 2 patients in the CT group received TMP/SMX decrement (<italic>P</italic> = 0.023).</p></sec><sec><title>Conclusion</title><p>The current study proposed that clindamycin combined with low-dose TMP/SMX was more effective and safer the than single use of TMP/SMX for severe PCP patients after renal transplantation (NCT 04328688).</p></sec>