PostScript Table 1 Summary of current PJP prophylaxis practice for solid tumour patients in UK Children’s Cancer and Leukaemia Group centres Number of responses Number of centres with a PJP guideline Number of centres using co-trimoxazole dosing regimens other than twice weekly based on surface area*
20 (100%) 6 (30%) 4 (20%)
*Standard dosing regimen from BNF and advocated in the UKALL 2011 trial. PJP, Pneumocystis jirovecii pneumonia.
UK survey of Pneumocystis jirovecii Pneumonia (PJP) prophylaxis use in paediatric oncology patients Pneumocystis jirovecii, previously known as Pneumocystis cariniii, is an opportunistic parasite that causes P. jirovecii pneumonia (PJP) in immunocompromised hosts. Most immunocompetent children acquire asymptomatic infection with P. jirovecii by the age of 4 years,1 while symptomatic disease occurs almost exclusively in severely immunocompromised hosts. Pneumocystis has been recognised as a cause of pneumonia since the 1940s when epidemics of ‘plasma cell pneumonia’ were diagnosed in malnourished and premature infants in care homes in Eastern Europe.2 In the 1960s, as immunosuppressive therapy for malignancy became more widespread, the incidence of PJP increased. Even with prompt antimicrobial treatment, PJP has a high mortality
i
Pneumocystis species demonstrate a high degree of host species specificity. Those infecting humans have been named P. jirovecii, while P. carinii refers to those infecting rats.
Arch Dis Child January 2015 Vol 100 No 1
rate3 but prophylaxis with co-trimoxazole is safe, effective and inexpensive.4 Although it is well established that children undergoing allogeneic stem cell transplants and treatment for leukaemia should be offered prophylaxis against PJP, the risk for children with solid malignancies is less certain and there are no evidence-based guidelines. Many treatment protocols for solid tumours do not specify whether prophylaxis is recommended or advised following local policy. As an initial step in developing Children’s Cancer and Leukaemia Group (CCLG) guidelines for PJP prophylaxis in solid tumour patients, all 20 UK CCLG centres were surveyed via email (table 1). Only 6 of the 20 UK CCLG centres currently have local guidelines for PJP prophylaxis. In most units, prophylaxis tends to be given at the discretion of individual consultants and varying doses are used from daily to twice or thrice weekly. We believe that, unless there are clear contraindications, all cancer patients undergoing immunosuppressive therapy should be offered prophylaxis with co-trimoxazole. The CCLG guidelines currently in development will more extensively review the evidence of efficacy and incorporate the views of patients and carer representatives, which should help standardise practice in this area and optimise the risk–benefit of prophylactic medication in this group of patients. Rebecca Proudfoot,1 Rachel Cox,2 Bob Phillips,3 Sophie Wilne4
4
Paediatric Oncology Department, University Hospitals Nottingham NHS Trust, Queen’s Medical Centre, Nottingham, UK Correspondence to Dr Rebecca Proudfoot, Department of Paediatric Oncology, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; Rebecca. [email protected] Correction notice This paper has been amended since it was published Online First. Pneumocystis was incorrectly spelt in the title of the paper and in the table footnote. Contributors RC had the initial idea for the survey; RP conducted the survey, collected the results and wrote the letter. All authors reviewed the final manuscript. Competing interests None. Provenance and peer review Not commissioned; internally peer reviewed. Data sharing statement Details of current practice at different CCLG centres re-PJP prophylaxis are available on request.
To cite Proudfoot R, Cox R, Phillips B, et al. Arch Dis Child 2015;100:115. Accepted 29 September 2014 Published Online First 16 October 2014 Arch Dis Child 2015;100:115. doi:10.1136/archdischild-2014-307515
REFERENCES 1
2
1
3
2
4
Department of Paediatric oncology, John Radcliffe Hospital, Oxford, UK Paediatric Oncology Department, Bristol Children’s Hospital, Bristol, UK 3 Centre for Reviews and Dissemination, University of York, York, UK
Vargas SL, Hughes WT, Santolaya ME, et al. Search for primary infection by Pneumocystis carinii in a cohort of normal, healthy infants. Clin Infect Dis 2001;32:855–61. GAJDUSEK DC. Pneumocystis carinii; etiologic agent of interstitial plasma cell pneumonia of premature and young infants. Pediatrics 1957;19:543–65. Thomas CF, Limper AH. Pneumocystis pneumonia. N Engl J Med 2004;350:2487–98. Hughes WT, Rivera GK, Schell MJ, et al. Successful intermittent chemoprophylaxis for Pneumocystis carinii pneumonitis. N Engl J Med 1987;316:1627–32.
115
Copyright of Archives of Disease in Childhood -- Education & Practice Edition is the property of BMJ Publishing Group and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
20 (100%) 6 (30%) 4 (20%)
*Standard dosing regimen from BNF and advocated in the UKALL 2011 trial. PJP, Pneumocystis jirovecii pneumonia.
UK survey of Pneumocystis jirovecii Pneumonia (PJP) prophylaxis use in paediatric oncology patients Pneumocystis jirovecii, previously known as Pneumocystis cariniii, is an opportunistic parasite that causes P. jirovecii pneumonia (PJP) in immunocompromised hosts. Most immunocompetent children acquire asymptomatic infection with P. jirovecii by the age of 4 years,1 while symptomatic disease occurs almost exclusively in severely immunocompromised hosts. Pneumocystis has been recognised as a cause of pneumonia since the 1940s when epidemics of ‘plasma cell pneumonia’ were diagnosed in malnourished and premature infants in care homes in Eastern Europe.2 In the 1960s, as immunosuppressive therapy for malignancy became more widespread, the incidence of PJP increased. Even with prompt antimicrobial treatment, PJP has a high mortality
i
Pneumocystis species demonstrate a high degree of host species specificity. Those infecting humans have been named P. jirovecii, while P. carinii refers to those infecting rats.
Arch Dis Child January 2015 Vol 100 No 1
rate3 but prophylaxis with co-trimoxazole is safe, effective and inexpensive.4 Although it is well established that children undergoing allogeneic stem cell transplants and treatment for leukaemia should be offered prophylaxis against PJP, the risk for children with solid malignancies is less certain and there are no evidence-based guidelines. Many treatment protocols for solid tumours do not specify whether prophylaxis is recommended or advised following local policy. As an initial step in developing Children’s Cancer and Leukaemia Group (CCLG) guidelines for PJP prophylaxis in solid tumour patients, all 20 UK CCLG centres were surveyed via email (table 1). Only 6 of the 20 UK CCLG centres currently have local guidelines for PJP prophylaxis. In most units, prophylaxis tends to be given at the discretion of individual consultants and varying doses are used from daily to twice or thrice weekly. We believe that, unless there are clear contraindications, all cancer patients undergoing immunosuppressive therapy should be offered prophylaxis with co-trimoxazole. The CCLG guidelines currently in development will more extensively review the evidence of efficacy and incorporate the views of patients and carer representatives, which should help standardise practice in this area and optimise the risk–benefit of prophylactic medication in this group of patients. Rebecca Proudfoot,1 Rachel Cox,2 Bob Phillips,3 Sophie Wilne4
4
Paediatric Oncology Department, University Hospitals Nottingham NHS Trust, Queen’s Medical Centre, Nottingham, UK Correspondence to Dr Rebecca Proudfoot, Department of Paediatric Oncology, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; Rebecca. [email protected] Correction notice This paper has been amended since it was published Online First. Pneumocystis was incorrectly spelt in the title of the paper and in the table footnote. Contributors RC had the initial idea for the survey; RP conducted the survey, collected the results and wrote the letter. All authors reviewed the final manuscript. Competing interests None. Provenance and peer review Not commissioned; internally peer reviewed. Data sharing statement Details of current practice at different CCLG centres re-PJP prophylaxis are available on request.
To cite Proudfoot R, Cox R, Phillips B, et al. Arch Dis Child 2015;100:115. Accepted 29 September 2014 Published Online First 16 October 2014 Arch Dis Child 2015;100:115. doi:10.1136/archdischild-2014-307515
REFERENCES 1
2
1
3
2
4
Department of Paediatric oncology, John Radcliffe Hospital, Oxford, UK Paediatric Oncology Department, Bristol Children’s Hospital, Bristol, UK 3 Centre for Reviews and Dissemination, University of York, York, UK
Vargas SL, Hughes WT, Santolaya ME, et al. Search for primary infection by Pneumocystis carinii in a cohort of normal, healthy infants. Clin Infect Dis 2001;32:855–61. GAJDUSEK DC. Pneumocystis carinii; etiologic agent of interstitial plasma cell pneumonia of premature and young infants. Pediatrics 1957;19:543–65. Thomas CF, Limper AH. Pneumocystis pneumonia. N Engl J Med 2004;350:2487–98. Hughes WT, Rivera GK, Schell MJ, et al. Successful intermittent chemoprophylaxis for Pneumocystis carinii pneumonitis. N Engl J Med 1987;316:1627–32.
115
Copyright of Archives of Disease in Childhood -- Education & Practice Edition is the property of BMJ Publishing Group and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
