Treatment of Pneumocystis jirovecii Pneumonia

Dosage Recommendations

• The American College of Physicians and other medical societies recommend a dosage of 15-20 mg/kg/day of trimethoprim and 75-100 mg/kg/day of sulfamethoxazole for the treatment of Pneumocystis jirovecii pneumonia, administered intravenously or orally in 3-4 divided doses for 14-21 days 1, 2
• For mild to moderate cases (pO2 ≥70 mmHg or alveolar-arterial oxygen difference AaDO2 <45 mmHg), oral therapy can be considered 1

Alternative Therapies

• Pentamidine intravenously (4 mg/kg/day) is a first alternative choice for treatment failure or intolerance to TMP-SMX 2
• Atovaquone oral suspension (750 mg twice daily with food) is an alternative therapy option 1
• Clindamycin (600 mg four times daily or 900 mg three times daily IV) plus primaquine (30 mg daily orally) is possibly the most effective alternative option 1, 2

Monitoring and Precautions

• Glucose-6-phosphate dehydrogenase deficiency should be excluded before administering dapsone or primaquine 1
• Complete blood counts with differential and platelets should be performed regularly 3
• Renal function and electrolytes should be monitored, especially in patients with underlying renal insufficiency 3
• If there is no clinical improvement within 8 days, a second infection should be considered and diagnostic procedures repeated 1