{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T19:22:47Z","timestamp":1780428167762,"version":"3.54.1"},"reference-count":27,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,9,23]],"date-time":"2020-09-23T00:00:00Z","timestamp":1600819200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transplant Infectious Dis"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Trimethoprim\u2010sulfamethoxazole (TMP\u2010SMX) is the drug of choice for<jats:italic>Pneumocystis jirovecii<\/jats:italic>pneumonia (PJP) prophylaxis and has activity against other opportunistic infections (OIs) after solid organ transplant (SOT). We aimed to describe the incidence, reasons for and outcomes of use of alternative prophylactic agents (APAs) across SOT programs in our high volume centers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Solid organ transplant recipients (SOTRs) at our centers from 1\/2015\u201012\/2016 were identified. Pharmacy records identified APA (pentamidine, atovaquone, or dapsone) use within 1\u00a0year. Records were reviewed for allergies, laboratory values at APA initiation, diagnostic tests for TMP\u2010SMX\u2010preventable OIs, and APA side effects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>An APA was initiated in 105\/1173 (8.9%) SOTRs. Of these, 51 (48.6%) were because of sulfonamide allergy recorded pre\u2010SOT, mostly rash\/hives (58.8%). The remaining 54 (51.4%) had TMP\u2010SMX discontinued post\u2010SOT, mostly for neutropenia (48%) and renal effects (34%). Differences occurred across programs, with kidney transplant never stopping TMP\u2010SMX for renal issues. Of those changed to APAs post\u2010transplant, 19 (35%) were later successfully re\u2010challenged with TMP\u2010SMX. With thresholds in mind, 67 (64%) received an APA unnecessarily, accounting for up to $100\u00a0000\/y excess cost. Potential TMP\u2010SMX\u2010preventable OIs occurred in 7 (5<jats:italic>Nocardia<\/jats:italic>; 2 PJP). APA side effects occurred in 14\/105 (13.3%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Use of APAs for PJP prophylaxis after SOT is less than previously reported but often unwarranted. Such decisions require scrutiny to avoid TMP\u2010SMX\u2010preventable OIs, cost and important APA side effects. Use of reasonable thresholds for cessation of TMP\u2010SMX and data\u2010driven approaches to re\u2010challenge would substantially reduce APA use.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tid.13461","type":"journal-article","created":{"date-parts":[[2020,9,16]],"date-time":"2020-09-16T07:41:34Z","timestamp":1600242094000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Alternative pneumocystis prophylaxis in solid organ transplant recipients at two large transplant centers"],"prefix":"10.1111","volume":"23","author":[{"given":"Jessica","family":"Lum","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases Cleveland Clinic Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6301-0121","authenticated-orcid":false,"given":"Ignacio","family":"Echenique","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Cleveland Clinic Florida Weston FL USA"},{"name":"Teva Pharmaceuticals Miramar FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8627-8411","authenticated-orcid":false,"given":"Vasilios","family":"Athans","sequence":"additional","affiliation":[{"name":"Department of Pharmacy University of Pennsylvania Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8196-2601","authenticated-orcid":false,"given":"Christine E.","family":"Koval","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Cleveland Clinic Cleveland OH 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