抄録
Trimethoprim-sulfamethoxazole (TMP/SMX) prophylaxis is used to prevent pneumocystis pneumonia (PCP) in patients with autoimmune diseases who usually receive corticosteroid therapy for longer than 4 weeks. However, patients with intraocular inflammation often receive corticosteroids for several weeks without TMP/SMX prophylaxis. Therefore, we investigated the frequency of TMP/SMX prophylaxis use and the incidence of PCP.
Overall, 192 patients received corticosteroids in the departments of ophthalmology and oculoplastic surgery at the Aichi Medical University Hospital from August 11, 2011 to May 6, 2019. The total corticosteroid dose was calculated. We collected patients' clinical data such as underlying disease, infection events, and risk factors of immunodeficiency.
All patients received ≥ 560 mg total prednisolone (PSL) dose during the treatment period; 38.6％ patients received higher corticosteroid dose (PSL > 20 mg/day for 28 days), and 5.2％ patients used TMP/SMX. Among the study population, 74 and 118 patients received corticosteroids at higher or lower doses of the PCP prophylaxis dose (PSL 20 mg/day ≥ 28 day), but 98.6％ (n = 73) and 98.3％ (n = 116) patients did not show respiratory infections, even though they had immunodeficiency risk factors. Additionally, no patient showed symptoms of PCP.
In conclusion, no patients developed PCP caused by corticosteroid therapy despite most patients not receiving TMP/SMX prophylaxis. Therefore, stereotypical TMP/SMX prophylaxis, only based on the steroid dosage and immunodeficiency data, is not recommended for intraocular inflammatory disease patients receiving corticosteroids.
