[Efficacy of clindamycin-primaquine as the salvage treatment for pneumocystis pneumonia in non-HIV-infected patients]

Objective: To evaluate the efficacy of clindamycin-primaquine as the salvage treatment for pneumocystis pneumonia (PCP) in non-HIV-infected patients. Methods: Clinical data of non-HIV-infected patients with PCP who were treated with clindamycin-primaquine as the salvage treatment in Peking University First Hospital from Jan 2010 to May 2016 were collected and reviewed in this retrospective study. Clinical outcomes were analyzed to evaluate the efficacy of clindamycin-primaquine as a salvage treatment. Results: A total of 19 non-HIV-infected patients with PCP were included. The average age was 44.6±16.1 years old. All patients had a history of glucocorticoids usage, and presented with fever, nonproductive cough and progressive dyspnea. The diagnoses were confirmed by positive methenamine silver staining in the induced sputum or bronchoalveolar lavage fluid. The reasons for the change of treatment were either failure of the first line therapy (13 cases) or severe adverse effects of the original treatment (6 cases). Ten patients were cured with the salvage treatment, while nine patients died. Four of thirteen patients who were switched due to treatment failure responded to clindamycin-primaquine treatment, while all the 6 patients who switched the treatment due to the severe adverse effects of trimethoprim-sulfamethoxazole were cured, the difference was statistically significant (P=0.011). Adverse reactions occurred in 3 cases, all of which were methemoglobinemia. Conclusion: In non-HIV-infected patients with PCP who have failed or can not tolerate the first-line therapy, clindamycin-primaquine may still be effective as a salvage treatment.