Info

🌱來自: Pneumocystis pneumonia, PJP, Adult

Alternative Regimens of Pneumocystis pneumonia, PJP, Adult

• Adult Treatment

• Patient not critically ill, able to take po meds:

• Clindamycin (300-450 mg po q6h + Primaquine 15 mg - 30 mg of base po q24h) x 21 days

• Atovaquone suspension, 750 mg po bid with food x 21 days

• All of above PLUS 

  • Prednisone 15-30 minutes before starting anti-PJP therapy: 40 mg po q12h x 5 days, then 40 mg q24h x 5 days, then 20 mg q24h x 11 days

• Then chronic suppression until CD4 count > 200 cells/μL

• Acutely ill patient, po therapy not possible:

• Prednisone (see Primary above), then:

• (Clindamycin 600 mg IV q8h + Primaquine base 15 - 30 mg po q24h) x 21 days

• Pentamidine 4 mg/kg/day IV x 21 days

• Then chronic suppression until CD4 count > 200 cells/μL for over 3 months

• Adult Prophylaxis

• Pentamidine 300 mg in 6 mL sterile water by aerosol every 4 weeks

• (Dapsone 200 mg po + Pyrimethamine 75 mg po + Folinic acid 25 mg po) once a week (also protection against Toxoplasmosis)(JAIDS 15:104, 1997)

• Atovaquone 1500 mg po q24h with food

• Treatment Failure: clinical failure is defined as absence of clinical response after 7 days.

  • Failure options include: (Clindamycin + Primaquine) or Pentamidine IV (J Acquir Immune Defic Syndrom 48:63, 2008) ± Caspofungin (70 mg IV x 1 dose & then 50 mg IV daily).