pulmonary disorders
Pneumocystis jirovecii Pneumonia
Treatment of Pneumocystis jirovecii Pneumonia
Trimethoprim/sulfamethoxazole Corticosteroids if PaO2<70 mm Hg Treatment is withtrimethoprim/sulfamethoxazole (TMP/SMX) 15 to 20 mg/kg IV or orally 3 times a day for 14 to 21 days. Treatment can be started before diagnosis is confirmed becauseP. jiroveciicysts persist in the lungs for weeks. Adverse effects of treatment are more common among patients with acquired immunodeficiency syndrome (AIDS) and include rash, neutropenia, hepatitis, and fever. Alternative regimens, which are also given for 21 days, are Pentamidine4 mg/kg IV once a day Atovaquone750 mg orally 2 times a day Trimethoprim5 mg/kg orally 3times a day withdapsone100 mg orally once a day Clindamycin900 mg IV every 8 hours, 600 mg IV every 6 hours, 600 mg orally 3 times a day, or 450 mg orally 4 times a day, plusprimaquinebase 30 mg orally once a day The major limitation ofpentamidineis the high frequency of toxic adverse effects, including acute kidney injury, hypotension, and hypoglycemia. Adjunctive therapy with corticosteroids is recommended for patients with a PaO2<70 mm Hg. The suggested regimen isprednisone40 mg orally twice a day (or its equivalent) for the first 5 days, 40 mg orally once a day for the next 5 days (or 20 mg twice a day), and then 20 mg orally once a day for the duration of treatment. 