The Authors' Reply to “The Addition of Prophylactic Antibiotics Can Achieve a Favorable Outcome”
Abstract
The Authors Reply We appreciated the constructive comments by Fukuchi et al. concerning prophylactic antibiotics in our case (1). As they pointed out, one tablet of sulfamethoxazole/trimethoprim (SMX/TMP) a day to prevent Pneumocystis jirovecii pneumonia should have been considered for our patient receiving high-dose corticosteroids. In several cases, however, clinicians avoid administering SMX/ TMP in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients because of the possible adverse effects, including skin eruption, bone marrow suppression, and renal impairment (2). In the present case, 1,500 mg/day of atovaquone was prescribed as an alternative for P. jirovecii pneumonia prophylaxis in order to avoid potential bone marrow suppression with SMX/TMP administration. Before hospitalization, a patient with underlying bronchiolitis obliterans was prescribed amoxicillin/clavulanate for bronchopneumonia because oral pathogens had been detected in bronchoscopy specimens. Although a recent systematic review and meta-analysis showed that fluoroquinolones had comparable effects on the mortality in cases of S. maltophilia infection as TMP/SMX, a sub-group analysis of patients with hematologic malignancies or neutropenia was not performed (3). In addition, several studies have shown that patients with hematologic malignancies are at risk of developing S. maltophilia infection even under treatment with levofloxacin or SMX/TMP at prophylactic doses (4, 5). Therefore,…
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