استعمال البنتاميدين كبديل للوقاية من ذات الرئة بالمتكيس الرئوي جيروفيسي لدى المصابين بالامراض الدموية والسرطانات

Background & Objective: TMP-SMX is the first choice drug to prevent Pneumocystis jiroveci pneumonia (PCP) in hemato-oncology patients. The utilization of alternative drugs (Pentamidine – Dapsone) was suggested in some protocols in hemato-oncology. It seems that there is an increase in the utilization of alternative drugs. The aim of the study was to evaluate the utilization of different drugs to prevent PCP and to identify the reasons which lead to the utilization of alternative drugs. Methods & Materials: The population in this study included patients seen in the haemato-oncology units of Sainte-Justine hospital, Montreal- Canada (leukemia, lymphoma, solid tumors and bone-marrow transplantation, it was a retrospective study. The majority of these patients received a prophylactic treatment against pneumonia due to Pneumocystis jiroveci. The definition of confirmation criteria for utilization of alternative drugs was allergy, digestive intolerance, hepatic enzyme elevation and neutropenia which have impact on patients’ treatment. Collection of data was done on 31st of May in three periods 2000, 2005 and 2010 for the utilization of TMP-SMX, Pentamidine and Dapsone. Results: the total number of patients who had Pentamidine was 135 while the number of patients who had TMP-SMX was 409. Bone-marrow transplantation was done in 48 of 135 patients in the alternative treatment.TMP-SMX was used as initial drug in 87 patients. The alternative drug was justified in 93 patients. Motives of alternative drug were: allergy in 26 patients, digestive intolerance 16 patients, neutropenia in 66 patients, hepato-toxicity in 8 patients, 1 G6PD deficit and other reason in 12 patients. The decision after 3 months of stopping the TMP-SMX was positive in 29 patients and the replacement of it was done in 46 patients. Conclusions: there was an increase in the utilization of alternative treatment to TMP-SMX which was justified in some cases and not justified in the others. Alternative treatment was consistently utilized in some cases when it can be replaced by standard drug.