Trimethoprim-Sulfamethoxazole (Bactrim) Dose Optimization in Pneumocystis jirovecii Pneumonia (PCP) Management: A Systematic Review

Abdul Haseeb, Mohammed A. S. Abourehab, Wesam Abdulghani Almalki, Abdulrahman Mohammed Almontashri, Sultan Ahmed Bajawi, Anas Mohammed Aljoaid, Bahni Mohammed Alsahabi, Manal Algethamy, Abdullmoin AlQarni, Muhammad Shahid Iqbal, Alaa Mutlaq, Saleh Alghamdi, Mahmoud E. Elrggal, Zikria Saleem, Rozan Mohammad Radwan, Ahmad Jamal Mahrous and Hani Saleh Faidah
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Abdul Haseeb: Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia
Mohammed A. S. Abourehab: Department of Pharmaceutics, Faculty of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia
Wesam Abdulghani Almalki: Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia
Abdulrahman Mohammed Almontashri: Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia
Sultan Ahmed Bajawi: Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia
Anas Mohammed Aljoaid: Department of Internal Medicine, Alnoor Specialist Hospital, Makkah 21955, Saudi Arabia
Bahni Mohammed Alsahabi: Department of Internal Medicine, Alnoor Specialist Hospital, Makkah 21955, Saudi Arabia
Manal Algethamy: Department of Infection Prevention and Control Program, Alnoor Specialist Hospital Makkah, Makkah 21955, Saudi Arabia
Abdullmoin AlQarni: Infectious Diseases Department, Alnoor Specialist Hospital Makkah, Makkah 21955, Saudi Arabia
Muhammad Shahid Iqbal: Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam bin Abdulaziz University, Alkharj 11942, Saudi Arabia
Alaa Mutlaq: General Department of Pharmaceutical Care, Ministry of Health, Riyadh 12211, Saudi Arabia
Saleh Alghamdi: Department of Clinical Pharmacy, Faculty of Clinical Pharmacy, Al Baha University, Al Baha 57911, Saudi Arabia
Mahmoud E. Elrggal: Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia
Zikria Saleem: Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore 40050, Pakistan
Rozan Mohammad Radwan: Pharmaceutical Care Department, Alnoor Specialist Hospital Makkah, Makkah 21955, Saudi Arabia
Ahmad Jamal Mahrous: Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia
Hani Saleh Faidah: Department of Microbiology, Faculty of Medicine, Umm Al Qura University, Makkah 21955, Saudi Arabia

IJERPH, 2022, vol. 19, issue 5, 1-11

Abstract: (1) Background: Pneumocystis jirovecii pneumonia (PCP) has a substantial impact on the morbidity and mortality of patients, especially those with autoimmune disorders, thus requiring optimal dosing strategies of Trimethoprim–Sulfamethoxazole (TMP-SMX). Therefore, to ensure the safety of TMP-SMX, there is a high demand to review current evidence in PCP patients with a focus on dose optimization strategies; (2) Methods: Various databases were searched from January 2000 to December 2021 for articles in English, focusing on the dose optimization of TMP-SMX. The data were collected in a specific form with predefined inclusion and exclusion criteria. The quality of each article was evaluated using a Newcastle–Ottawa Scale (NOS) for retrospective studies, Joanna Briggs Institute (JBI) critical checklist for case reports, and Cochrane bias tool for randomized clinical trials (RCTs); (3) Results: Thirteen studies met the inclusion criteria for final analysis. Of the 13 selected studies, nine were retrospective cohort studies, two case reports, and two randomized controlled trials (RCT). Most of the studies compared the high-dose with low-dose TMP-SMX therapy for PCP. We have found that a low dose of TMP-SMX provides satisfactory outcomes while reducing the mortality rate and PCP-associated adverse events. This strategy reduces the economic burden of illness and enhances patients’ compliance to daily regimen plan; (4) Conclusions: The large-scale RCTs and cohort studies are required to improve dosing strategies to prevent initial occurrence of PCP or to prevent recurrence of PCP in immune compromised patients.

Keywords: Pneumocystis jirovecii pneumonia; dose optimization; trimethoprim-sulfamethoxazole; co-trimoxazole (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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