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

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

Abstract

Objective: Evaluate the effect of the combination of clindamycin with low-dose trimethoprim-sulfamethoxazole (TMP/SMX) regimen on sever Pneumocystis pneumonia (PCP) after renal transplantation.

Method: 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).

Results: 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, P = 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%, P = 0.008), the length of hospital staying (26.5 vs. 39.0 days, P = 0.011) and ICU staying (12.5 vs. 22.5 days, P = 0.008). Furthermore, more thrombocytopenia (9/10 vs. 3/10, P = 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, P < 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 (P = 0.023).

Conclusion: 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 (NCT04328688).

Keywords: Pneumocystis pneumonia; clindamycin; combination; renal transplantation; trimethoprim-sulfamethoxazole.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Gu, Liu, Huang, Liu, He, Yang, Liu, Xu, Rong, Zhu, Luo and Ju.

Figures

FIGURE 1
FIGURE 1
Patient-selection flow chart.
FIGURE 2
FIGURE 2
Daily P/F ratio of PCP patients after renal transplantation. For patients in the CT group, the P/F ratio had been elevated to more than 300 mmHg in the 6th ICU day. On the other hand, the P/F ratio of patients from T group could not be higher than 300 mmHg before the 12th ICU day.
FIGURE 3
FIGURE 3
Comparison of the improvement of P/F ratio between CT group and T group. After the 6th ICU day, the improvement of P/F ratio was more significantly in the CT group than in the T group.

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