Efficacy of caspofungin combined with trimethoprim/sulfamethoxazole as first‑line therapy to treat non‑HIV patients with severe pneumocystis pneumonia

  • Authors:
    • Gensheng Zhang
    • Miaomiao Chen
    • Shufang Zhang
    • Hongwei Zhou
    • Xiaozhen Ji
    • Jiachang Cai
    • Tianzheng Lou
    • Wei Cui
    • Ning Zhang
  • View Affiliations

  • Published online on: November 16, 2017     https://doi.org/10.3892/etm.2017.5516
  • Pages:1594-1601
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Abstract

Combined treatment with caspofungin and trimethoprim/sulfamethoxazole (TMP/SMZ) as salvage therapy in non‑HIV positive patients with severe pneumocystis pneumonia (PCP) yields poor outcomes. It remains unknown whether the use of this combination strategy as a first‑line therapy would improve patient outcomes. The present study aimed to assess the efficacy of caspofungin combined with TMP/SMZ as a first‑line therapy in non‑HIV positive patients with severe PCP. A retrospective cohort study was conducted between March 2016 and February 2017. Patient clinical characteristics and outcomes were compared between two groups receiving first‑line and second‑line therapy respectively. In addition, similar cases from previous studies were assessed. A total of 14 patients were included in the present study (mean age, 58.79±14.41 years); including 9 patients receiving caspofungin and TMP/SMZ as a first‑line therapy and 5 that received it as a second‑line therapy. The overall positive response rate was 71.43% (10/14), with 88.89 (8/9) and 40.00% (2/5) in the first‑line and second‑line therapy groups, respectively (P=0.095). The positive response rates of patients requiring invasive mechanical ventilation differed significantly between the first‑line (5/6, 83.33%) and the second‑line (0/3, 0%) therapy groups (P=0.048). All‑cause hospital mortality was 42.86% (6/14), with mortality rates of 33.33 (3/9) and 60.00% (3/5) in the first‑line and second‑line therapy groups, respectively (P=0.580). Combined with previously reported cases (n=27), the positive response rate was significantly greater in the first‑line therapy group (11/12, 91.67%) than in the second‑line therapy group (8/15, 53.33%, P=0.043). No significant differences were in all‑cause mortality rates between the two groups (25.00 vs. 46.67%, P=0.424) were identified, despite the fact that all‑course mortality in the first‑line therapy group was ~50% that of the second‑line therapy group. Therefore, the results of the present study indicate that combined caspofungin and TMP/SMZ as first‑line therapy may be a promising and effective strategy to treat non‑HIV positive patients with severe PCP, particularly for those requiring invasive mechanical ventilation.

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February 2018
Volume 15 Issue 2

Print ISSN: 1792-0981
Online ISSN:1792-1015

2016 Impact Factor: 1.261
Ranked #50/128 Medicine Research and Experimental
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APA
Zhang, G., Chen, M., Zhang, S., Zhou, H., Ji, X., Cai, J. ... Zhang, N. (2018). Efficacy of caspofungin combined with trimethoprim/sulfamethoxazole as first‑line therapy to treat non‑HIV patients with severe pneumocystis pneumonia. Experimental and Therapeutic Medicine, 15, 1594-1601. https://doi.org/10.3892/etm.2017.5516
MLA
Zhang, G., Chen, M., Zhang, S., Zhou, H., Ji, X., Cai, J., Lou, T., Cui, W., Zhang, N."Efficacy of caspofungin combined with trimethoprim/sulfamethoxazole as first‑line therapy to treat non‑HIV patients with severe pneumocystis pneumonia". Experimental and Therapeutic Medicine 15.2 (2018): 1594-1601.
Chicago
Zhang, G., Chen, M., Zhang, S., Zhou, H., Ji, X., Cai, J., Lou, T., Cui, W., Zhang, N."Efficacy of caspofungin combined with trimethoprim/sulfamethoxazole as first‑line therapy to treat non‑HIV patients with severe pneumocystis pneumonia". Experimental and Therapeutic Medicine 15, no. 2 (2018): 1594-1601. https://doi.org/10.3892/etm.2017.5516