What is the treatment of choice for Pneumocystis jiroveci pneumonia (PJP)?

Updated: Apr 24, 2019
  • Author: Shelley A Gilroy, MD, FACP, FIDSA; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Answer

Answer

While officially classified as a fungal pneumonia, P jiroveci pneumonia (PJP) does not respond to antifungal treatment. The treatment of choice is TMP-SMX, with second-line agents including pentamidine, dapsone (often in combination with pyrimethamine), or atovaquone. However, there are a few reports of successful caspofungin administration in PJP. Echinocandins such as caspofungin may be active against Pneumocystis based on their activity against the inclusion of (1-3)beta-D glucan into the fungal cell wall, but clinical data are lacking. Case reports suggest it may be worthy of consideration as a salvage treatment option in nonresponsive cases, and further research is clearly warranted. [32]


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