Upload
others
View
4
Download
0
Embed Size (px)
Citation preview
InfoCard #: APBMT-COMM-017 Rev. 05 Effective Date: 01 Apr 2019
DukeMedicineDivision of Cellular Therapy
^AbULT ANb PEbIATRIC BLOOD AND
MARROW TRANSPLANT PROGRAM
DOCUMENT NUMBER: APBMT-COMM-017
DOCUMENT TITLE:
Pneumocystis Jiroveci Pneumonia (PJP) Prophylaxis
DOCUMENT NOTES:
Document Information
Revision: 05 Vault: APBMT-Common-rel
Status: Release Document Type: Common
Date Information
Creation Date: 15 Feb 2019 Release Date: 01 Apr 2019
Effective Date: 01 Apr 2019 Expiration Date:
Control Information
Author: MOORE171 Owner: MOORE171
Previous Number: APBMT-COMM-017 Rev 04 Change Number: APBMT-CCR-141
CONFIDENTIAL - Printed by: ACM93 on 01 Apr 2019 08:41:49 am
lnfoCard#:APBMT-COMM-017 Rev. 05 Effective Date: 01 Apr 2019
APBMT-COMM-017PNEUMOCYSTIS JIROVECI PNEUMONIA (PJP) PROPHYLAXIS
1 PURPOSE
1. 1 To provide a consistent approach to the prevention ofpneumocystisjirovecipneumonia (PJP, formerly PCP; formerly pneumocystis carinii pneumonia) inautologous and allogeneic hematopoietic stem cell transplant recipients.
2 INTRODUCTION
2. 1 Level: Interdependent: Physicians, advanced practice providers, nurses, andpharmacists (*requires an order from physician or physician designee to beplaced in EPIC).
2. 2 Supportive Data: Recipients ofhematopoietic stem cell transplant (HSCT)recipients are at risk of developing opportunistic infections, including PJP. Therisk is dependent on the degree ofimmunosuppression experienced by the patientboth during prior therapy and after transplantation.
3 SCOPE AND RESPONSIBILITES
3. 1 The Adult and Pediatric Blood and Marrow Transplant (APBMT) medical teamwill provide medical management of the patient.
3. 2 The nursing staff formally trained and experienced in management of patientsreceiving cellular therapy will provide supportive care and administer anytreatment ordered by the medical team.
4 DEFINITIONS/ACRONYMS
4. 1 APBMT Adult and Pediatric Blood and Marrow Transplant
Graft versus Host Disease
Hematopoietic Stem Cell Transplant
Pneumocyctisi camii pneumonia
Pneumocystis jiroveci pneumonia
5
6
7
4.2
4.3
4.4
4.5
GvHD
HSCT
PCP
PJP
MATERIALS
5.1 N/A
EQUIPMENT
6.1 N/A
SAFETY
7.1 N/A
APBMT-COMM-017 Pneumocystis Jiroveci Pneumonia (PJP) ProphylaxisAPBMT, DUMCDurham, NC
CONFIDENTIAL - Printed by: ACM93 on 01 Apr 2019 08:41:49 am
Page 1 of 4
8 § ^ I u 0 ^ CD § 4^
*.
CD §
^^
Ill 3^!
S O
R'II 5' I ri I 2 3 7 1 i
00
^ 0 -b 4^
Q-
0 0
o % 3
S-
&1 ^ ^ 4^ I TO ^ ^ I s:
l<
. M 3 00 ^ ^ g- t< /^^
c .o ^ 0 0 3 TO.
0 1-{
00 t-ft
M '"F'
0' i 0 I A to t M 0 ^1 EO
~ni
I 0 ^- *<:
. § g TO ^ I- ^ 2 -t § TO .a 0 i. s
00
lyi
.n 0 1 1 0 3 £? v M to ^ 0 -^
to TO CT
00
u\ ^ I 0 3 n
00
1^1
> fl> 1-t
3 p> a H 3-
0> I
§ ^II
a.
^ & s-^'
3-
S-
I! S'
OQ
5-^
's. t
5-.
D-
S'
c.
3
-~-1
2 ^ It It y
i »-
?-
N" S
.".
2'
11 <T>
><;
00 4^ 10 M ? !s
l0
? 3
0
- .?
VI 5-^
oOQ
VI
^ S
2.
^ z
=
"~
^-a
s
?r
o^
sII
'c'
-0^ ^
s.
':<
1^
£i
ri
rt.
<??o
a.
li ? 3
-n
zs-
s'! t! C
L<^
&i
en "> I I ?
lli
33
^to
(T
O
to
i'"?' l
:0 « Is
-^
^A
x IIs
j-1^
i§|
^3
=.
aw
. 3
(73
-2..
11
00
4^ 1^>
> a.
c: <-t
-
Q.
0 w 3 m
4^ 1^> I 3 OQ
00 4^
^
° 2-
^I
5- 3
§.
Ill i
a-
S. -^
00 4^ -T\ ^ r I
=r
0 0 (§
s3
V(/
1
r-f-3'"S
0 O
T ^
I? I
lit
C?
""
tos
?.N
n o
c S
<7
2=1
^<
l0> M
SO
03
.s ^^ w
S
ff> '3
^.§
3 3: s
'1:
5^Q
5
. ^.
s? 5
-£
0 W
^ ^
00
^>
.
T3
(T>
-fl
tf> »
Q 0
'a-.
s=
^
ill
2.
?"
-^
!ti
ill'
lit
ill
lit
Ill
p y
i^l
^©
l- ^ 13 II ?1
0 ^ t! II:
1'^
I n TO
00 h->
11.1
1?r
3 i
2.
ii li
c
yi
o ^
I 1-
1
0 c
S- s'
00
a ^
' a >
;.^
£0
=S
3^3?
^
S.
3
S.CT
- g: ^
^
If I
Ill ill
§ 5
" 3.
I il.
0
6
=^
? s
s:
Ill
a-
2. 5
I i:i
&-J
?
G-
lw^
S'
^L'
ft)
^ 2 si.§
^ s'
s-1
° ^
I s ^
3.
ii^
3 ^
0.
00^
s.
03
0&
. 3
CT"TO
s s s C) <.;
E G
3 c I M I " Ul
in 0 3 p? 3 CL
§^
^i
^1 0 0 II'
II
s g IS.
"
0' I d 3 0 C! 3
0aT
O II:
^ I§ 1^
s ^
ft
L^i
1^
I en c vs x 0 us
i§-
Oq 0
§1 (g I3 c I! ff £
^ ~
00 i. r 0 3 o
n ^ { I 1- '-<' M~
x a;
I a :lt 3 I I ? I s i s' t N>
0
8.2
8.3
InfoCard #: APBMT-COMM-017 Rev. 05 Effective Date: 01 Apr 2019
8. 1. 5. 2 Pentamidine:
8. 1. 5. 2. 1 For patients >5 years of age:
. 300 mg inhaled monthly
8. 1. 5. 2.2 For patients 2-5 years of age:
. 150 mg inhaled monthly
8. 1. 5. 2. 3 For patients unable to comply with inhaledtherapy choose one of the following:
. Pentamidine:
> 4 mg/kg/dose IV monthly
. Atovaquone (dosing based on age):
> 1-3 months of age: 30 mg/kg/day withfood (up to 1500mg)> 4-24 months of age: 45 mg/kg/day oncedaily with food (up to 1500 mg)> 24 months to 13 years of age: 30mg/kg/day once daily with food (up to 1500mg)> ^13 years of age: 1 500 mg po daily withfood
Use before stem cell engraftment (neutrophils and platelets):
8.2. 1 Trimethoprim/sulfamethoxazole should be discontinued prior to stemcell infusion and resumed only after stem cell engraftment (Absoluteneutrophil count (ANC) greater than or equal to 1000).
8. 2. 2 Dapsone:
8. 2. 2. 1 Indicated for those allergic or intolerant totrimethoprim/sulfamethoxazole;
8. 2. 2.2 Caution should be used in sulfonamide-allergic individuals;
8. 2. 2. 3 Rarely causes hemolysis or methemoglobinemia.
8.2. 3 Inhaled pentamidine may be used in the time-period after cell infusionwhile waiting for engraftment.
8. 2. 3. 1 Consider use ofalbuterol before inhaled pentamidine.
Reportable Conditions
8. 3. 1 Intolerance or allergy to prophylactic regimen.
RELATED DOCUMENTS/FORMS
9. 1 N/A
APBMT-COMM-017 Pneumocystis Jiroveci Pneuinonia (PJP) ProphylaxisAPBMT, DUMCDurham. NC
CONFIDENTIAL - Printed by: ACM93 on 01 Apr 2019 08:41:49 am
Paee 3 of 4
InfoCard #: APBMT-COMM-017 Rev. 05 Effective Date: 01 Apr 2019
10 REFRENCES
10.1 Centers for Disease Control and Prevention. Guidelines for preventingopportunistic infections among hematopoietic stem cell transplant recipients:recommendations ofCDC, the Infectious Disease Society of America, and theAmerican Society of Blood and Marrow Transplantation. MMWR 2000;49(No. RR-10):25-6,106.
11 REVISION HISTORY
Revision No.
05Author
SallyMcCollum
Description of Change(s)- Acronyms defined throughout- Dosing for Atovaquone in pediatrics updated.- Removed reference to negative pressure room
requirements for pediatrics.- Combined second and third line therapies under
header of "Alternate Therapy" given any may bechosen based on patient status/clinical preference.
- Added pediatric dosing for Bactrim.
APBMT-COMM-017 Pneumocystis Jiroveci Pneumonia (PJP) ProphylaxisAPBMT, DUMCDurham, NC
CONFIDENTIAL - Printed by: ACM93 on 01 Apr 2019 08:41:49 am
Page 4 of 4
lnfoCard#:APBMT-COMM-017 Rev. 05 Effective Date: 01 Apr 2019
Signature Manifest
Document Number: APBMT-COMM-017
Title: Pneumocystis Jiroveci Pneumonia (PJP) Prophylaxis
Revision: 05
All dates and times are in Eastern Time.
APBMT-COMM-017 Pneumocystis Jiroveci Pneumonia (PJP) Prophylaxis
Author
Name/Signature ; TitleSally McCollum (MOORE171)
Management
I Date I Meaning/Reason
14 Mar 2019, 11:08:58 AM Approved
' Name/Signature
Nelson Chao (CHA00002)
Medical Director
Title Date | Meaning/Reason14Mar2019, 11:19:16AM Approved
; Name/Signature
Joanne Kurtzberg(KURTZ001)
Quality
Title ! Date ! Meaning/Reason
14 Mar 2019, 03:28:39 PM Approved
j Name/Signature
Bing Shen (BS76)
Document Release
Title Date
18 Mar 2019, 12:24:09 PM
j Meaning/Reason
Approved
Name/Signature
Betsy Jordan (BJ42)
Title Date18 Mar 2019, 01:41:23 PM
I Meaning/Reason
Approved
CONFIDENTIAL - Printed by: ACM93 on 01 Apr 2019 08:41:49 am