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PCP prophylaxis during ICI
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PCP prophylaxis during ICI

› Forums › General Melanoma Community › PCP prophylaxis during ICI

  • Post
    • October 10, 2021 at 7:56 am
    kathycaribe
    Participant
      Has anyone been on PCP prophylaxis during immunotherapy with or without steroids? My MD Anderson doc put me on Bactrim and aggressively weaned me off dex and now that I’m off dex I’m thinking I no longer need the Bactrim (and this seems to be backed up by studies https://link.springer.com/article/10.1007/s00277-021-04452-9 ) and this study seems to indicate increased risk for WBRT and SRS (https://mycology.adelaide.edu.au/docs/cooley-2014-anzjm.pdf).

      The primary concern I have is developing resistance (as Bactrim is the primary treatment for PCP and PJP).

      So I;m looking for anecdotal experience of Bactrim (TMP-SMX) during ICI with or without steroid use. Thanks!

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        • October 10, 2021 at 11:12 am
        Bubbles
        Participant
          Hi Kathy,

          I do NOT presume to know all there is that is going on with your situation.  However, in all my years dealing with melanoma and melanoma patients, PCP has never been a big issue.  Unless your docs have some particular reason to think your risk for this is high, I would wish to come off Bactrim ASAP not because of a fear of developing resistance, but because (as was noted in one of the papers you sited) that we have learned that folks on antibiotics before or at the start of immunotherapy tend to have a poorer response.

          Here are lots of reports over several years (see links contained within intro) if you are interested:  https://chaoticallypreciselifeloveandmelanoma.blogspot.com/2020/08/the-gut-microbiome-again.html

          As I note in all reports I post related to antibiotic use – when needed they are nothing short of life saving.  So, if your docs think your risk is significant enough to require them – that is one thing.  However, the data included in these many studies would certainly be something I would want to discuss.

          I wish you my best.  Celeste

          • October 10, 2021 at 6:50 pm
          kathycaribe
          Participant
            Thanks so much! That makes a lot of sense.
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