Children and teens on chemotherapy take antibiotics two to three days each week to prevent pneumocystis pneumonia (PCP). They usually keep taking the antibiotics a few months to a year after treatment ends. The antibiotic of choice for PCP prevention is a combination drug containing sulfamethoxazole and trimethoprim; it is sold under the brand names Bactrim® and Septra®. This antibiotic can cause gastrointestinal upset, skin rashes, sun sensitivity, and low blood counts. If a substitute is needed, one of the following is used:

• Pentamidine is administered by IV once a month, as an aerosol, or through a nebulizer. Use of the nebulizer can be difficult for children because it takes 20 minutes to administer and it smells and tastes bad.
• Dapsone® is a pill given once a day.

The oncologist explained it this way. Bactrim® is the best prophylactic antibiotic for PCP (pneumocystis), but it can affect counts. Pentamidine IV can affect counts, but nebulizer treatments (once a month) usually don’t. Dapsone® can be used, but it can cause anemia. We just started the Dapsone® because Katie was starting to buck the nebulizer treatment because it smells and tastes horrible. The Bactrim® costs about $3/month, the Dapsone about $7/month, and the pentamidine nebulizer treatment is about $300/month!