Abstract
The treatment of choice for all forms pneumocystis pneumonia is trimetoprim 15-20 mg/kg/d and sulfamethoxazole 75-100mg/kg/d divided into four daily doses, for 21 days. Dose is adjusted to creatinin clearance and in case of intravenous treatment also to drug levels.
Mild adverse reactions or a history of mild allergy do not justify a treatment change. Alternative regimens for moderate to severe form is clindamycin plus primaquine or intravenous pentamidine, for mild to moderate form clindamycin plus primaquine or trimetoprim plus dapson or atovaquon.
In moderate to severe cases we strongly suggest adding corticosteroids as soon as possible at a prednisone dose of 40 mg twice daily for Day 1-5, 40 mg/day for Day 6-11 and then 20 mg/day until Day 21. All patients who are already being treated withcorticosteroids should continue the treatment at a minimal dose of 2x40 mg.
If their current dose is higher taperin should not start before respiratory stabilization. Corticosteroids are recomended as a treatment of respiratory worsening due to lysis of pneumocystic following soon after start of therapy.
Before treatment failure is stated, other infections, pneumothorax, fluid overload etc. should be excluded. It is important to wait at least 7 days before switching of the therapy.
Isolation of patients in a single room is recommended.