What is the treatment for Pneumocystis (Pneumocystis jirovecii) pneumonia?

From the Guidelines

Pneumocystis pneumonia (PCP) treatment typically involves the administration of trimethoprim-sulfamethoxazole (TMP-SMX) at a dose of 15-20 mg/kg/day of trimethoprim and 75-100 mg/kg/day of sulfamethoxazole, divided into 3-4 doses per day, for a duration of at least 2 weeks 1.

Alternative Regimens

• Pentamidine isethionate at a dose of 4 mg/kg/day intravenously
• Clindamycin and primaquine at doses of 600-900 mg orally every 6-8 hours and 15-30 mg orally daily, respectively 1

Important Considerations

• Oxygen therapy and supportive care are also essential components of PCP treatment, particularly for patients with severe disease
• Glucose-6-phosphate dehydrogenase deficiency must be excluded before administration of dapsone or primaquine 1
• Systemic corticosteroids may be beneficial in AIDS patients with respiratory failure due to PCP, but data are conflicting in non-HIV patients 1

Duration of Treatment

• Treatment with TMP-SMX should be continued for at least 2 weeks 1
• Clinical improvement should develop within 8 days, otherwise a second infection should be considered and diagnostic procedures repeated 1

From the FDA Drug Label

The recommended dosage for treatment of patients with documented Pneumocystis jirovecii pneumonia is 75 mg/kg to 100 mg/kg sulfamethoxazole and 15 mg/kg to 20 mg/kg trimethoprim per 24 hours given in equally divided doses every 6 hours for 14 to 21 days

• The treatment for Pneumocystis (Pneumocystis jirovecii) pneumonia is sulfamethoxazole and trimethoprim.
• The recommended dosage is 75 mg/kg to 100 mg/kg sulfamethoxazole and 15 mg/kg to 20 mg/kg trimethoprim per 24 hours, given in equally divided doses every 6 hours for 14 to 21 days 2.

From the Research

Treatment Options for Pneumocystis jirovecii Pneumonia

• The treatment of choice for Pneumocystis jirovecii pneumonia (PCP) is trimethoprim-sulfamethoxazole (TMP-SMX) 3, 4, 5, 6, 7
• The conventional dose of TMP-SMX is 15-20 mg/kg/day of trimethoprim, but lower doses may be effective and have a better safety profile 5, 6, 7
• Studies have shown that low-dose TMP-SMX (≤10 mg/kg/day of trimethoprim) can be effective in treating PCP with fewer adverse events 5, 6, 7
• In patients with severe PCP, high-dose TMP-SMX may be necessary, and alternative treatments such as primaquine plus clindamycin may be considered in patients with intolerance to TMP-SMX 4
• The treatment duration for PCP is typically 3 weeks, and secondary anti-PCP prophylaxis is indicated in all patients thereafter 4

Efficacy and Safety of Low-Dose TMP-SMX

• Low-dose TMP-SMX has been shown to have similar efficacy to conventional-dose TMP-SMX in treating PCP 5, 6, 7
• Low-dose TMP-SMX is associated with a lower incidence of adverse events, including nausea, hyponatremia, and other grade 3 or higher adverse events 5, 6, 7
• The initial treatment completion rates are higher in patients treated with low-dose TMP-SMX compared to conventional-dose TMP-SMX 6, 7

Patient Populations

• The treatment of PCP in HIV-infected patients is typically with TMP-SMX, and low-dose TMP-SMX may be effective in this population 3
• In non-HIV infected patients, low-dose TMP-SMX may be a treatment option, especially in those with underlying diseases such as connective tissue disease 6, 7