From the Guidelines
The recommended dose of atovaquone for treating Pneumocystis jirovecii pneumonia (PCP) is 750 mg taken orally twice daily with food for 21 days, as indicated for mild cases, especially in patients with sulfonamide allergy 1. This dosage is specifically recommended for patients who cannot tolerate trimethoprim-sulfamethoxazole, a first-line treatment for PCP.
- Atovaquone is an effective alternative due to its mechanism of action, which involves inhibiting mitochondrial electron transport in the parasite, thus disrupting nucleic acid and ATP synthesis.
- It's crucial to administer atovaquone with food, as this significantly enhances its absorption, with fatty meals increasing bioavailability.
- Common side effects of atovaquone include rash, nausea, diarrhea, headache, and elevated liver enzymes, which should be monitored during treatment. For malaria treatment, the specific dosage of atovaquone alone is not clearly defined in the most recent and highest quality evidence provided, but it is often used in combination with proguanil (as Malarone) for both treatment and prophylaxis 1.
- The combination of atovaquone-proguanil is recommended for malaria prophylaxis, taken once daily with food, starting 1-2 days before travel to endemic areas, continuing during the stay, and for 7 days after return. Given the most recent evidence from 1, which provides a clear recommendation for the dosage of atovaquone in the treatment of PCP, this guideline should be followed in clinical practice to ensure the best outcomes in terms of morbidity, mortality, and quality of life.
From the FDA Drug Label
The recommended oral dosage is 1,500 mg (10 mL) once daily administered with food. The recommended oral dosage is 750 mg (5 mL) twice daily (total daily dose = 1,500 mg) administered with food for 21 days.
The recommended dose of Atovaquone for:
- Prevention of Pneumocystis jirovecii pneumonia (PCP): 1,500 mg (10 mL) once daily with food.
- Treatment of mild-to-moderate PCP: 750 mg (5 mL) twice daily with food for 21 days. There is no information in the provided drug labels about the dose for treating malaria 2, 2, 2.
From the Research
Atovaquone Dose for PCP and Malaria
- The recommended dose of Atovaquone for treating Pneumocystis jirovecii pneumonia (PCP) is 750mg three times daily, administered in tablet form 3, 4.
- For patients with mild to moderate PCP, a dosage of 750mg three times daily has similar overall therapeutic efficacy to conventional therapies such as oral cotrimoxazole and intravenous pentamidine 3.
- Atovaquone suspension is also effective and well tolerated for the treatment of PCP, with a recommended dose of 750mg twice a day 5.
- For the prevention of PCP, atovaquone suspension at 1500mg once a day has an efficacy similar to that of aerosolized pentamidine 6.
- For the treatment of malaria, atovaquone is often used in combination with proguanil, with a recommended dose of 250/100 mg in adults and dosage based on bodyweight in children >/=11 kg 7.
Dosage Considerations
- The FDA-approved dosage regimen for atovaquone in treating mild to moderate PCP is 750 mg (three 250-mg tablets) administered orally three times daily with food for 21 days 4.
- Atovaquone should be taken with food, particularly food with a high fat content, to enhance absorption 4.
- The incidence of treatment-limiting adverse events with atovaquone is lower than with trimethoprim-sulfamethoxazole and pentamidine isethionate 3, 4.