{"id":910,"date":"2014-04-16T20:08:10","date_gmt":"2014-04-16T19:08:10","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/adc\/?p=910"},"modified":"2014-03-28T22:29:21","modified_gmt":"2014-03-28T21:29:21","slug":"a-spoonful-of-septrin-helps-the-carinii-stay-down","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/adc\/2014\/04\/16\/a-spoonful-of-septrin-helps-the-carinii-stay-down\/","title":{"rendered":"A spoonful of Septrin helps the carinii stay down?"},"content":{"rendered":"

\"\"\u00a0While the diagnosis of\u00a0Pneumocystis carinii\u00a0<\/em>Pneumonia (yes – I know it’s changed it s name – but really, do you ask for Beanz when you want something tomatoey to go with your sausage, egg, black pudding, fried bread, mushrooms and juice in a morning?) may not be everyone’s weekly occurrence, there are probably a handful of children who are trying very hard not to develop in in your town.<\/p>\n

The traditional approach to prophylaxis has been a spoonful of Septrin (TM), which got modifed to three times\/week. \u00a0Most of the UK leukaemia fraternity now moves with a twice\/week, twice\/day approach. But in Italy, there are centre which use a once-per-week schedule.<\/p>\n

“On the basis of large RCT?” I hear you ask, knowing the great reputation paed onc has for developing research.<\/p>\n

“Not .. quite..” comes back the embarrassed answer. “But there is some evidence …?”<\/p>\n

<\/p>\n

A paper<\/a> has recently popped up looking at the impact of dosing schedules on PCP prevention. This was a prospective one-year survey of centres, with their routine prophylaxis and routine diagnostic approaches, assessing the rates of PCP diagnosis. Some centres used 3\/week, some 2\/week, and three 1\/week.<\/p>\n

The most striking thing is that there were only two cases of PCP. And these turned out not to have taken their prophylaxis.<\/p>\n

But the 1\/week group – all 689 patients – there was not a single case.<\/p>\n

Is this strong evidence for using 1\/week? Well, it’s not randomised – so the group that got the 1\/week might be systematically different than the others – but given it’s centre based not person based, this is likely to be influential if there is a marked geographical variation in PCP or in distribution of underlying malignancy (which is unlikely). Its not blinded; so there may be issues with patients presenting differentially, or being investigated differentially … but is it reasonable to assume that breathless patients on 1\/week would be less likely to turn up than 2\/ or 3\/week? Or would the folk at centres differ in their approach to investigating ? (Well \u00a0– \u00a0that might be the case. There may well be a systematic difference in approach.)<\/p>\n

Follow-up and change-in-approach (crossover) are pretty negligable in the guideline driven world that is paed onc.<\/p>\n

Even if there is a systematic difference in investigation, that’s a ridiculously low rate of PCP. Is that in itself safe enough as 1\/week, and make life easier for all our patients?<\/p>\n

– Bob Phillips<\/p>\n

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 <\/p>\n","protected":false},"excerpt":{"rendered":"

\u00a0While the diagnosis of\u00a0Pneumocystis carinii\u00a0Pneumonia (yes – I know it’s changed it s name – but really, do you ask for Beanz when you want something tomatoey to go with your sausage, egg, black pudding, fried bread, mushrooms and juice in a morning?) may not be everyone’s weekly occurrence, there are probably a handful of […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[79],"tags":[],"class_list":["post-910","post","type-post","status-publish","format-standard","hentry","category-archimedes"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/posts\/910","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/comments?post=910"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/posts\/910\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/media?parent=910"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/categories?post=910"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/tags?post=910"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}