What antibiotic regimen are effective for treatment of 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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Antibiotics are primarily recommended for treatment of mild, moderate, or severe P jiroveci pneumonia (PJP). TMP-SMX has been shown to be as effective as intravenous pentamidine and more effective than other alternative treatment regimens. [2, 34] The parenteral route may be considered in patients who present with serious illness or in those with gastrointestinal side effects.

Thomas et al have reported that a lower dose of TMP-SMX (10 mg/kg/d) is effective for PJP associated with HIV infection and carries fewer side effects, [35] but this should not yet be taken as a recommendation. Recent guidelines have been published. [36]

TMP-SMX is the preferred initial therapy during pregnancy according to consensus guidelines. The patient’s neonatologist should be informed if the medication is used near delivery because of potential for hyperbilirubinemia and kernicterus. For the treatment of infections that are resistant to TMP-SMX, the combination of clindamycin and primaquine is likely to be more effective than intravenous pentamidine. [37, 38]

The recommended duration of treatment for PJP is 21 days in patients with HIV infection and 14 days in all other patients. Patients infected with HIV tend to have a higher organism burden and respond to treatment slower than patients without HIV infection and therefore require a longer duration of therapy.

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