Pneumocystis carinii pneumonia prophylaxis with atovaquone in trimethoprim-sulfamethoxazole-intolerant orthotopic liver transplant patients: A preliminary study

Pneumocystis carinii pneumonia (PCP) is an opportunistic infection associat ed with increased morbidity and mortality in solid-organ and bone-marrow tr ansplant recipients. Side effects of trimethoprim-sulfamethoxazole (TMP/SMX ) are frequent; therefore, we performed a preliminary study using atovaquon e suspension, 750 mg once daily, for I year for the prevention of PCP in li ver transplant recipients intolerant to TMP/SMX therapy. Twenty-eight patie nts were treated, and data were analyzed for efficacy and toxicity. Adverse events occurred in 14 subjects, mainly related to the gastrointestinal tra ct. Side effects from TMP/SMX i.e., rash, completely resolved and bone-marr ow suppression improved in 62% of patients. No patients developed Pneumocys tis carinii infection. Although a lower dose of atovaquone once daily may b e effective in transplant recipients, further studies are necessary to conf irm this preliminary observation.