[PAGID] Pneumocystis in HIGM

[Lisa Kobrynski, MD, MPH]

I was wondering if anyone had experienced problems with failure of bactrim
prophylaxis in patients with hyperIgM.

One of our hyperIgM patients has had multiple episodes of pneumocystis pneumonia
despite reported compliance with daily bactrim for prophylaxis.  Pneumocystis
was isolated on BAL on at least one occasion and all episodes have been typical
for pneumocystis pneumonitis and resolved with high dose bactrim and steroids. 
He has been tried on Atovoquone and failed this medication as well, and could
not tolerate IV Pentamidine.

Has anyone seen failure of prophylaxis with Bactrim?  
What other prophylactic/therapeutic agents would you recommend?

Thanks

Lisa Kobrynski, MD, MPH
Assistant Professor of Pediatrics
Division of Allergy and Immunology
Emory University
404-727-3575
404-727-5045 (fax)