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A retrospective study of intravenous pentamidine for PCP prophylaxis in adult patients with hematological malignancies - its utility during respiratory virus pandemics.

BACKGROUND: In Haematology, prophylaxis for Pneumocystis jirovecii pneumonia (PCP) is recommended for patients undergoing hematopoietic stem cell transplantation and in selected categories of intensive chemotherapy for hematological malignancies. Trimethoprim-sulfamethoxazole (TMP-SMX) is the recommended first-line agent, but its use is not straightforward. Inhaled pentamidine is the recommended second-line agent but aerosolized medications were discouraged during respiratory virus outbreaks, especially during the COVID-19 pandemic, in view of potential contamination risks. Intravenous (IV) pentamidine is a potential alternative agent.

AIM: We evaluated the effectiveness and tolerability of IV pentamidine use for PCP prophylaxis in adult allogeneic HSCT recipients and patients with hematological malignancies during COVID-19.

FINDINGS: A total of 202 unique patients who received 239 courses of IV pentamidine, with a median of 3 doses received (1-29). The largest group of the patients (49.5%) who received IV pentamidine were undergoing or had received a hematopoietic stem cell transplant. The commonest reason for not using TMP-SMX prophylaxis was cytopenia (34.7%). We have no patients who had breakthrough PCP infection while on IV pentamidine. None of the patients develop an infusion reaction or suffer adverse effects from IV pentamidine Conclusion: Pentamidine administered IV monthly is safe and effective.

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