Alternative antimicrobial therapy for adults with high-severity PJP
For adults with high-severity PJP who are hypersensitive to trimethoprim+sulfamethoxazole, useCooley 2014European AIDS Clinical Society (EACS) 2022Panel on Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV, 2022:
1clindamycin 450 mg orally (or enterally), 6-hourly for 21 days clindamycin clindamycin clindamycin
PLUS
primaquine 30 mg orally (or enterally), daily for 21 days12 primaquine primaquine primaquine
OR as a single drug
1pentamidine 4 mg/kg up to 300 mg intravenously, daily; see below for advice on intravenous to oral switch. For dosage adjustment in adults with kidney impairment, see pentamidine dosage adjustment. pentamidine pentamidine pentamidine
If clindamycin plus primaquine is preferred but oral clindamycin is not tolerated, replace oral clindamycin in the above regimen with:
clindamycin 900 mg intravenously, 8-hourly; see below for advice on intravenous to oral switch. clindamycin clindamycin clindamycin
Consider if adjunctive corticosteroid therapy is required.
Intravenous to oral switch: once the patient improves, switch to oral therapy. For guidance on when to switch to oral therapy, see Guidance for intravenous to oral switch. Use oral clindamycin plus primaquine (see dosages above) to complete 21 days of therapy (intravenous + oral).
After completing 21 days of therapy, maintenance therapy (secondary prophylaxis) for PJP may be required for adults with immune compromise (eg patients with HIV infection or cancer, organ transplant recipients).