{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:18:38Z","timestamp":1787761118725,"version":"build-2784847793"},"reference-count":51,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2022,2,28]],"date-time":"2022-02-28T00:00:00Z","timestamp":1646006400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006701","name":"Umm Al-Qura University","doi-asserted-by":"publisher","award":["19-MED-1-01-0037"],"award-info":[{"award-number":["19-MED-1-01-0037"]}],"id":[{"id":"10.13039\/501100006701","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>(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\u2013Sulfamethoxazole (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\u2013Ottawa 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\u2019 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.<\/jats:p>","DOI":"10.3390\/ijerph19052833","type":"journal-article","created":{"date-parts":[[2022,2,28]],"date-time":"2022-02-28T20:09:57Z","timestamp":1646078997000},"page":"2833","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Trimethoprim-Sulfamethoxazole (Bactrim) Dose Optimization in Pneumocystis jirovecii Pneumonia (PCP) Management: A Systematic Review"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2455-5054","authenticated-orcid":false,"given":"Abdul","family":"Haseeb","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1348-6567","authenticated-orcid":false,"given":"Mohammed A. S.","family":"Abourehab","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutics, Faculty of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wesam Abdulghani","family":"Almalki","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8747-5233","authenticated-orcid":false,"given":"Abdulrahman Mohammed","family":"Almontashri","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sultan Ahmed","family":"Bajawi","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2996-5394","authenticated-orcid":false,"given":"Anas Mohammed","family":"Aljoaid","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Alnoor Specialist Hospital, Makkah 21955, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bahni Mohammed","family":"Alsahabi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Alnoor Specialist Hospital, Makkah 21955, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manal","family":"Algethamy","sequence":"additional","affiliation":[{"name":"Department of Infection Prevention and Control Program, Alnoor Specialist Hospital Makkah, Makkah 21955, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullmoin","family":"AlQarni","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Alnoor Specialist Hospital Makkah, Makkah 21955, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0245-5976","authenticated-orcid":false,"given":"Muhammad Shahid","family":"Iqbal","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam bin Abdulaziz University, Alkharj 11942, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alaa","family":"Mutlaq","sequence":"additional","affiliation":[{"name":"General Department of Pharmaceutical Care, Ministry of Health, Riyadh 12211, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7975-933X","authenticated-orcid":false,"given":"Saleh","family":"Alghamdi","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, Faculty of Clinical Pharmacy, Al Baha University, Al Baha 57911, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud E.","family":"Elrggal","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3202-6347","authenticated-orcid":false,"given":"Zikria","family":"Saleem","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore 40050, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rozan Mohammad","family":"Radwan","sequence":"additional","affiliation":[{"name":"Pharmaceutical Care Department, Alnoor Specialist Hospital Makkah, Makkah 21955, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7140-741X","authenticated-orcid":false,"given":"Ahmad Jamal","family":"Mahrous","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hani Saleh","family":"Faidah","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine, Umm Al Qura University, Makkah 21955, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1513\/pats.201009-062WR","article-title":"HIV-associated Pneumocystis pneumonia","volume":"8","author":"Huang","year":"2011","journal-title":"Proc. Am. Thorac. Soc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2487","DOI":"10.1056\/NEJMra032588","article-title":"Pneumocystis pneumonia","volume":"350","author":"Thomas","year":"2004","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s13075-016-1206-8","article-title":"Optimal regimens of sulfamethoxazole-trimethoprim for chemoprophylaxis of Pneumocystis pneumonia in patients with systemic rheumatic diseases: Results from a non-blinded, randomized controlled trial","volume":"19","author":"Utsunomiya","year":"2017","journal-title":"Arthirits Res. Ther."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1571","DOI":"10.1038\/s41598-017-01818-w","article-title":"Risk factors for Pneumocystis jirovecii pneumonia (PJP) in kidney transplantation recipients","volume":"7","author":"Lee","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Li, R., Tang, Z., Liu, F., and Yang, M. (2021). Efficacy and safety of trimethoprim-sulfamethoxazole for the prevention of Pneumocystis pneumonia in human immunodeficiency virus-negative immunodeficient patients: A systematic review and meta-analysis. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0248524"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"White, P.L., Price, J.S., and Backx, M. (2018). Therapy and management of Pneumocystis jirovecii infection. J. Fungi, 4.","DOI":"10.3390\/jof4040127"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e01813-17","DOI":"10.1128\/AAC.01813-17","article-title":"Population Pharmacokinetics of Trimethoprim-Sulfamethoxazole in Infants and Children","volume":"62","author":"Autmizguine","year":"2017","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1136\/annrheumdis-2017-211796","article-title":"Prophylactic effect of trimethoprim-sulfamethoxazole for Pneumocystis pneumonia in patients with rheumatic diseases exposed to prolonged high-dose glucocorticoids","volume":"77","author":"Park","year":"2018","journal-title":"Ann. Rheum. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2004","DOI":"10.1002\/cncr.2820360612","article-title":"Intensity of immunosuppressive therapy and the incidence of Pneumocystis carinii pneumonitis","volume":"36","author":"Hughes","year":"1975","journal-title":"Cancer"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1097\/MPH.0000000000000804","article-title":"Efficacy and Safety of Dapsone Versus Trimethoprim\/Sulfamethoxazol for Pneumocystis jirovecii Prophylaxis in Children with Acute Lymphoblastic Leukemia with a Background of Ethnic Neutropenia","volume":"39","author":"Nazir","year":"2017","journal-title":"J. Pediatr. Hematol. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/2110-5820-4-13","article-title":"Cotrimoxazole\u2014Optimal dosing in the critically ill","volume":"4","author":"Brown","year":"2014","journal-title":"Ann. Intensive Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4081\/gh.2020.868","article-title":"Employment of mapping technology in antimicrobial resistance reporting in Saudi Arabia","volume":"15","author":"Alhifany","year":"2020","journal-title":"Geospatial Health"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1007\/s15010-015-0851-1","article-title":"Treatment of Pneumocystis pneumonia with intermediate-dose and step-down to low-dose trimethoprim-sulfamethoxazole: Lessons from an observational cohort study","volume":"44","author":"Kroon","year":"2016","journal-title":"Infection"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"280","DOI":"10.7326\/0003-4819-109-4-280","article-title":"Trimethoprim-sulfamethoxazole compared with pentamidine for treatment of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome: A prospective, noncrossover study","volume":"109","author":"Sattler","year":"1988","journal-title":"Ann. Intern. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1056\/NEJM199009203231202","article-title":"Oral therapy for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome: A controlled trial of trimethoprim\u2014Sulfamethoxazole versus trimethoprim\u2014Dapsone","volume":"323","author":"Medina","year":"1990","journal-title":"N. Eng. J. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1097\/00002030-199203000-00007","article-title":"Trimethoprim-sulfamethoxazole versus pentamidine for Pneumocystis carinii pneumonia in AIDS patients: Results of a large prospective randomized treatment trial","volume":"6","author":"Klein","year":"1992","journal-title":"AIDS"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"792","DOI":"10.7326\/0003-4819-124-9-199605010-00003","article-title":"Comparison of three regimens for treatment of mild to moderate Pneumocystis carinii pneumonia in patients with AIDS: A double-blind, randomized trial of oral trimethoprim-sulfamethoxazole, dapsone-trimethoprim, and clindamycin-primaquine","volume":"124","author":"Safrin","year":"1996","journal-title":"Ann. Intern. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/j.jcma.2016.01.007","article-title":"High daily doses of trimethoprim\/sulfamethoxazole are an independent risk factor for adverse reactions in patients with Pneumocystis pneumonia and AIDS","volume":"79","author":"Chang","year":"2016","journal-title":"J. Chin. Med. Assoc."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Haseeb, A., Faidah, H.S., Alghamdi, S., Alotaibi, A.F., Elrggal, M.E., Mahrous, A.J., Almarzoky Abuhussain, S.S., Obaid, N.A., Algethamy, M., and AlQarni, A. (2021). Dose Optimization of Colistin: A Systematic Review. Antibiotics, 10.","DOI":"10.3390\/antibiotics10121454"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1016\/j.jsps.2020.08.005","article-title":"Evaluation of Antimicrobial Stewardship Programs (ASPs) and their perceived level of success at Makkah region hospitals, Kingdom of Saudi Arabia","volume":"28","author":"Haseeb","year":"2020","journal-title":"Saudi Pharm. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/2046-4053-4-1","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement","volume":"4","author":"Moher","year":"2015","journal-title":"Syst. Rev."},{"key":"ref_22","unstructured":"Wells, G., Connell, D., Peterson, J., Welch, V., and Losos, M. (2014). Newcastle-Ottawa Quality Assessment Scale Cohort Studies, University of Ottawa."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Higgins, J.P., Savovi\u0107, J., Page, M.J., Elbers, R.G., and Sterne, J.A. (2019). Assessing risk of bias in a randomized trial. Cohrane Database Syst. Rev., 205\u2013228.","DOI":"10.1002\/9781119536604.ch8"},{"key":"ref_24","first-page":"7","article-title":"Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: What are they and which is better?","volume":"7","author":"Ma","year":"2020","journal-title":"Mil. Med. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.curtheres.2014.08.003","article-title":"Serum peak sulfamethoxazole concentrations demonstrate difficulty in achieving a target range: A retrospective cohort study","volume":"76","author":"Dao","year":"2014","journal-title":"Curr. Ther. Res."},{"key":"ref_26","first-page":"253","article-title":"Effectiveness and safety of lower dose sulfamethoxazole\/trimethoprim therapy for Pneumocystis jirovecii pneumonia in patients with systemic rheumatic diseases: A retrospective multicenter study","volume":"25","author":"Ohmura","year":"2019","journal-title":"BMC Infect. Dis."},{"key":"ref_27","first-page":"664","article-title":"Safety and efficacy evaluation of low-dose trimethoprim-sulfamethoxazole for prophylaxis of Pneumocystis pneumonia in HIV uninfected patients undergoing hemodialysis: A retrospective observational study","volume":"21","author":"Yamashita","year":"2021","journal-title":"J. Infect. Chemother."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e01173-17","DOI":"10.1128\/AAC.01173-17","article-title":"A four-center retrospective study of the efficacy and toxicity of low-dose trimethoprim-sulfamethoxazole for the treatment of Pneumocystis pneumonia in patients without HIV infection","volume":"61","author":"Kosaka","year":"2017","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1016\/j.jmii.2017.07.007","article-title":"Low-dose trimethoprim-sulfamethoxazole treatment for Pneumocystis pneumonia in non-human immunodeficiency virus-infected immunocompromised patients: A single-center retrospective observational cohort study","volume":"51","author":"Nakashima","year":"2018","journal-title":"J. Microb. Immunol. Infect."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12879-019-3944-0","article-title":"Safety and efficacy of prophylaxis for Pneumocystis jirovecii pneumonia involving trimethoprim-sulfamethoxazole dose reduction in kidney transplantation","volume":"19","author":"Prasad","year":"2019","journal-title":"BMC Infect. Dis."},{"key":"ref_31","first-page":"e14445","article-title":"A Rare Case of Pneumocystis Pneumonia in HIV Patient on Glucocorticoid","volume":"13","author":"Rehman","year":"2021","journal-title":"Cureus"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.1111\/jcpt.13220","article-title":"Use of trimethoprim-sulfamethoxazole in a patient with G6PD deficiency for treating Pneumocystis jirovecii pneumonia without haemolysis: Case report and literature review","volume":"45","author":"Lu","year":"2020","journal-title":"J. Clin. Pharm. Ther."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"rkaa029","DOI":"10.1093\/rap\/rkaa029","article-title":"An open-label, randomized controlled trial of sulfamethoxazole\u2013trimethoprim for Pneumocystis prophylaxis: Results of 52-week follow-up","volume":"4","author":"Utsunomiya","year":"2020","journal-title":"Rheumatol. Adv. Pract."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"210","DOI":"10.7182\/pit2015153","article-title":"Tolerability of low-dose sulfamethoxazole\/trimethoprim for Pneumocystis jirovecii pneumonia prophylaxis in kidney transplant recipients","volume":"25","author":"Zmarlicka","year":"2015","journal-title":"Prog. Transplant."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1186\/s13075-019-1996-6","article-title":"Pneumocystis pneumonia in patients with rheumatic diseases receiving prolonged, non-high-dose steroids\u2014Clinical implication of primary prophylaxis using trimethoprim\u2013sulfamethoxazole","volume":"21","author":"Park","year":"2019","journal-title":"Arthritis Resp. Ther."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2405","DOI":"10.1093\/jac\/dkw158","article-title":"ECIL guidelines for treatment of Pneumocystis jirovecii pneumonia in non-HIV-infected haematology patients","volume":"71","author":"Maschmeyer","year":"2016","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1016\/j.semarthrit.2018.10.018","article-title":"Pneumocystis jirovecii pneumonia (PJP) prophylaxis patterns among patients with rheumatic diseases receiving high-risk immunosuppressant drugs. in Seminars in arthritis and rheumatism","volume":"48","author":"Schmajuk","year":"2019","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1016\/j.transproceed.2009.03.004","article-title":"A systematic review of two different trimetoprim\u2013sulfamethoxazole regimens used to prevent Pneumocystis jirovecii and no prophylaxis at all in transplant recipients: Appraising the evidence","volume":"41","author":"Orlando","year":"2009","journal-title":"Transplant. Proc."},{"key":"ref_39","unstructured":"Sadiq, U., Shrestha, U., and Guzman, N. (2020). Prevention of Opportunistic Infections in HIV, StatPearls Publishing."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Haseeb, A., Faidah, H.S., Algethamy, M., Alghamdi, S., Alhazmi, G.A., Alshomrani, A.O., Alqethami, B.R., Alotibi, H.S., Almutiri, M.Z., and Almuqati, K.S. (2022). Antimicrobial Usage and Resistance in Makkah Region Hospitals: A Regional Point Prevalence Survey of Public Hospitals. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19010254"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1111\/ajt.12119","article-title":"Pneumocystis pneumonia in solid organ transplantation","volume":"13","author":"Martin","year":"2013","journal-title":"Am. J. Transplant."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1111\/ajt.14498","article-title":"Taking the challenge: A protocolized approach to optimize Pneumocystis pneumonia prophylaxis in renal transplant recipients","volume":"18","author":"Urbancic","year":"2018","journal-title":"Am. J. Transplant."},{"key":"ref_43","first-page":"38","article-title":"Prevention of Opportunistic Infections (OI) in Patients with HIV Infection","volume":"12","author":"Justin","year":"2021","journal-title":"JAIDS J. Acquir. Immune Defic. Syndr."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1128\/CMR.17.4.770-782.2004","article-title":"Prevention of infection due to Pneumocystis spp. in human immunodeficiency virus-negative immunocompromised patients","volume":"17","author":"Rodriguez","year":"2004","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"293","DOI":"10.3390\/jof1030293","article-title":"Pneumocystis Pneumonia in Solid-Organ Transplant Recipients","volume":"1","author":"Iriart","year":"2015","journal-title":"J. Fungi"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Butler-Laporte, G., Smyth, E., Amar-Zifkin, A., Cheng, M.P., McDonald, E.G., and Lee, T.C. (2020). Low-Dose TMP-SMX in the Treatment of Pneumocystis jirovecii Pneumonia: A Systematic Review and Meta-analysis. Open Forum Infectious Diseases, Oxford University Press.","DOI":"10.1093\/ofid\/ofaa112"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2222","DOI":"10.3389\/fphar.2020.570238","article-title":"Evaluation of a Multidisciplinary Antimicrobial Stewardship Program in a Saudi Critical Care Unit: A Quasi-Experimental Study","volume":"11","author":"Haseeb","year":"2021","journal-title":"Front. Pharmacol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1874","DOI":"10.1056\/NEJMc070728","article-title":"Pneumocystis pneumonia associated with infliximab in Japan","volume":"357","author":"Harigai","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"R43","DOI":"10.1186\/ar4472","article-title":"Prophylaxis for Pneumocystis pneumonia in patients with rheumatoid arthritis treated with biologics, based on risk factors found in a retrospective study","volume":"16","author":"Katsuyama","year":"2014","journal-title":"Arthritis Res. Ther."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e5","DOI":"10.1111\/ijd.13396","article-title":"Weighing the risks and benefits of Pneumocystis pneumonia prophylaxis in iatrogenically immunosuppressed dermatology patients","volume":"56","author":"Lehman","year":"2017","journal-title":"Int. J. Dermatol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1007\/s11926-017-0664-6","article-title":"Pneumocystis Pneumonia and the Rheumatologist: Which Patients Are At Risk and How Can PCP Be Prevented?","volume":"19","author":"Wolfe","year":"2017","journal-title":"Curr. Rheumatol. Rep."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/5\/2833\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:29:30Z","timestamp":1760135370000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/5\/2833"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,28]]},"references-count":51,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["ijerph19052833"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19052833","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,28]]}}}