Jennifer A Cox

Publications (2)5.47 Total impact

• Article: Intravenous Pentamidine Is Safe and Effective as Primary Pneumocystis Pneumonia Prophylaxis in Children and Adolescents Undergoing Hematopoietic Stem Cell Transplantation.

  James M Demasi, Jennifer A Cox, David Leonard, Andrew Y Koh, Victor M Aquino
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  ABSTRACT: BACKGROUND:: Pneumocystis carinii pneumonia (PCP) is a potentially life-threatening but preventable infection that may occur after hematopoietic stem cell transplantation (HSCT). Intravenous pentamidine has been used in the prevention of PCP in the post-transplant period, although there are few trials published in the literature evaluating its safety and efficacy. METHODS:: We retrospectively reviewed the medical records of children who underwent HSCT from Jan 1, 2005 - October 1, 2011 who received intravenous pentamidine as first line PCP prophylaxis initiated at admission. Demographic, clinical, microbiologic, management, and outcome data was collected. RESULTS:: 167 consecutive HSCT in 137 pediatric patients were given intravenous pentamidine before myeloablation and then every 28 days until the subject was at least a minimum 30 days post HSCT, had stable neutrophil engraftment (ANC >1000/mm2 for three days without growth factor support), and for allogeneic patients no evidence of active GVHD and weaning on immunosuppressive therapy. No cases of PCP were seen in this cohort. Ten (7%) had a grade I side effect of nausea/vomiting requiring slower infusion time and 2 (2%) had a grade IV reaction with anaphylaxis (rash) and hypotension with one child requiring transfer to the intensive care unit. CONCLUSIONS:: Intravenous pentamidine was safe and effective for the prevention of PCP in pediatric HSCT patients. Given the potential neutropenic effects of trimethoprim-sulfamethoxazole, compliance with drug administration, and inferior efficacy of other PCP prophylactic medications, intravenous pentamidine should be considered as first line therapy in the prevention of PCP in children undergoing HSCT.
  The Pediatric Infectious Disease Journal 03/2013; · 3.58 Impact Factor
• Article: The diagnostic utility of routine chest radiography in the evaluation of the initial fever in patients undergoing hematopoietic stem cell.

  Jennifer A Cox, James DeMasi, Susan McCollom, Gevel Jackson, Douglas Scothorn, Victor M Aquino
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  ABSTRACT: A routine chest radiograph is often performed to evaluate initial fever in patients undergoing hematopoietic stem cell transplantation (HSCT) given the signs and symptoms of infectious pulmonary pathology may be subtle or absent. Studies in patients receiving conventional chemotherapy have shown that chest radiographs do not appear to be helpful in the evaluation of asymptomatic patients with febrile neutropenia. We performed a retrospective review of pediatric stem cell transplant recipients to determine if chest radiographs are useful in the evaluation of initial fever. We retrospectively identified 81 consecutive pediatric hematopoietic stem transplant recipients who had a chest radiograph performed as a routine part of the evaluation of initial fever during stem cell transplantation. Seventy-six (94%) of the chest radiographs performed had no evidence of pulmonary infiltrate. Of the five children with positive radiographs, three had symptomatic respiratory infection and two (40%) were asymptomatic. One asymptomatic patient had a history of pulmonary infection with persistent stable infiltrates prior to transplantation. This patient did not have any evidence of pneumonia during the transplant. The second asymptomatic patient had subsequent resolution of the infiltrate with antibiotic administration. None of the patients had a change made in the empiric antibiotic regimen based upon the results of the chest film. Routine radiographs are not useful in the evaluation of asymptomatic children at the time of an initial febrile event while undergoing HSCT.
  Pediatric Blood & Cancer 10/2011; 57(4):666-8. · 1.89 Impact Factor