Trimethoprim-Sulfamethoxazole versus Aerosolized Pentamidine for PJP Prophylaxis after Allogeneic Hematopoietic Cell Transplantation: Association with Bacterial Infections and Survival.

Authors

Takashi Jiromaru, Yasuo Mori, Kohta Miyawaki, Yu Kochi, Takeshi Sugio, Yoshikane Kikushige, Goichi Yoshimoto, Akihiko Numata, Koji Kato, Toshihiro Miyamoto, Koichi Akashi

Published in

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy. Pages 103074. Sep 12, 2026. Epub Sep 12, 2026.

Abstract

Trimethoprim-sulfamethoxazole (TMP-SMX) is the first-line prophylaxis for Pneumocystis jirovecii pneumonia (PJP) after allogeneic hematopoietic cell transplantation (allo-HCT). Aerosolized pentamidine (AP) is commonly used as an alternative in patients intolerant to TMP-SMX. However, the comparative impact of these strategies on non-PJP infections and transplant outcomes remains unclear.
We retrospectively analyzed 123 allo-HCT recipients who received PJP prophylaxis with TMP-SMX (n = 42) or AP (n = 81) after engraftment. The primary endpoints were the incidence of PJP and documented bacterial infections. Secondary endpoints included risk factors for bacterial infections, safety, and overall survival (OS).
PJP incidence was low in both groups, with no cases in the TMP-SMX group and one case in the AP group. The 1-year cumulative incidence of documented bacterial infections was significantly lower in the TMP-SMX group than in the AP group (3.0% vs. 30.4%, p=0.0003). In multivariate analysis, AP use was identified as an independent risk factor for bacterial infections (Odds ratio 12.4; 95% CI 2.46-62.8). Many pathogens isolated in the AP group were susceptible to TMP-SMX. During the observation period, OS did not differ significantly between the TMP-SMX and AP groups (p=0.29).
TMP-SMX prophylaxis was associated with a reduced risk of bacterial infections compared with AP. TMP-SMX may be considered the preferred option for patients who can tolerate the regimen, and switching from AP to TMP-SMX may be appropriate after recovery from treatment-related toxicities.

PMID:
42731623
Bibliographic data and abstract were imported from PubMed on 13 Sep 2026.

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