Combination of clindamycin and primaquine for Pneumocystis pneumonia in renal transplant recipients

Abstract

Pneumocystis pneumonia (PCP) in kidney transplant recipients is usually treated with trimethoprim-sulfamethoxazole (TMP-SMX). Combination of clindamycin and primaquine (C + P) is recommended for treatment failure. Data are scarce for treatment with C + P in renal transplant recipients. Here, we present three kidney transplant recipients on triple immunosuppression (tacrolimus, mycophenolate mofetil, and prednisolone) diagnosed to have PCP at different time periods after transplant surgery. Bronchoscopy and lavage were done; special staining with Gomori methenamine silver stain demonstrated Pneumocystis jirovecii. Two patients had graft dysfunction at the time of diagnosis. The first patient was started on TMP-SMX but developed leukopenia and was started on oral C + P. The other two cases had graft dysfunction and were started on C + P. All responded to therapy without complications, and improvement in graft function was observed. Clindamycin with primaquine can be considered as a safe and effective option to treat PCP in renal transplant recipients; this combination can replace TMP-SMX, as the first-line therapy, especially in patients with graft dysfunction or leukopenia

Keywords

• Clindamycin
• Pneumocystis pneumonia
• posttransplant infection
• primaquine
• trimethoprim-sulfamethoxazole