From the Guidelines
Pneumocystis carinii pneumonia (PCP) should be treated with trimethoprim-sulfamethoxazole (TMP-SMX) as the first-line treatment, at a dose of 15-20 mg/kg/day of the trimethoprim component, divided into three or four doses for 21 days, as recommended by the most recent and highest quality study 1.
Treatment Overview
The treatment of PCP involves the use of antimicrobial agents, with TMP-SMX being the preferred choice.
- The dose of TMP-SMX is typically 15-20 mg/kg/day of the trimethoprim component, divided into three or four doses for 21 days.
- For moderate to severe cases, adjunctive corticosteroids (prednisone 40 mg twice daily for 5 days, then 40 mg daily for 5 days, followed by 20 mg daily for 11 days) should be started within 72 hours of treatment, as suggested by 1.
Alternative Treatments
Alternative treatments for patients who cannot tolerate TMP-SMX include:
- Pentamidine
- Dapsone plus trimethoprim
- Atovaquone
- Clindamycin plus primaquine These alternatives are recommended by various studies, including 1 and 1.
Prophylaxis
Prophylaxis is recommended for high-risk patients, particularly those with CD4 counts below 200 cells/μL, using TMP-SMX (one double-strength tablet daily) as recommended by 1 and 1.
Key Considerations
- PCP causes infection by attaching to alveolar epithelium, triggering inflammation that damages lung tissue and impairs oxygen exchange, leading to hypoxemia and respiratory failure if untreated.
- The treatment and prophylaxis of PCP should be guided by the most recent and highest quality evidence, with a focus on reducing morbidity, mortality, and improving quality of life.
From the FDA Drug Label
Pneumocystis Carinii Pneumonia: Treatment: Adults and Children The recommended dosage for treatment of patients with documented Pneumocystis carinii pneumonia is 75 to 100 mg/kg sulfamethoxazole and 15 to 20 mg/kg trimethoprim per 24 hours given in equally divided doses every 6 hours for 14 to 21 days. Pneumocystis Carinii Pneumonia: For the treatment of documented Pneumocystis carinii pneumonia and for prophylaxis against Pneumocystis carinii pneumonia in individuals who are immunosuppressed and considered to be at an increased risk of developing Pneumocystis carinii pneumonia
The treatment for Pneumocystis carinii pneumonia is trimethoprim and sulfamethoxazole. The recommended dosage is 75 to 100 mg/kg sulfamethoxazole and 15 to 20 mg/kg trimethoprim per 24 hours given in equally divided doses every 6 hours for 14 to 21 days 2. Prophylaxis is also indicated for individuals who are immunosuppressed and considered to be at an increased risk of developing Pneumocystis carinii pneumonia 2.
From the Research
Pneumocystis Carinii Pneumonia Treatment
- The first-line treatment for Pneumocystis carinii pneumonia (PCP) is trimethoprim-sulfamethoxazole (TMP-SMX) 3, 4, 5.
- Pentamidine isethionate is an alternative treatment for patients who are intolerant to TMP-SMX or have failed to respond to it 3, 4, 5.
- Other treatment options include clindamycin with primaquine, dapsone with trimethoprim, and atovaquone 4, 6, 7.
- Adjunctive corticosteroids are recommended for patients with moderate to severe PCP, defined as a room air arterial PaO2 less than 70 mm Hg or an alveolar-arterial oxygen gradient of greater than 35 mm Hg 3, 4.
Pneumocystis Carinii Pneumonia Prevention
- Primary prophylaxis is recommended for HIV-positive individuals with CD4+ lymphocyte counts < 0.20 x 10(9)/L or a CD4: total lymphocyte ratio of < 1.5, constitutional symptoms, or with other AIDS-defining diseases 4.
- Secondary prophylaxis is recommended after a first episode to prevent recurrence 4.
- The first choice for primary and secondary prophylaxis is oral co-trimoxazole 960 mg od or three times a week 4.
- Alternative prophylaxis options include nebulized pentamidine and dapsone (with or without pyrimethamine) 4, 5.