Alternative antimicrobial therapy for children with high-severity PJP

For children with high-severity PJP who are hypersensitive to trimethoprim+sulfamethoxazole, useCooley 2014Panel on Opportunistic infections in HIV-exposed and HIV-infected children 2022:

Consider if adjunctive corticosteroid therapy is required.

Intravenous to oral switch: once the child improves, switch to oral therapy. For guidance on when to switch to oral therapy, see Guidance for intravenous to oral switch. Use atovaquone to complete 21 days of therapy (intravenous + oral); for atovaquone dosage, see Alternative treatment for children with low- to moderate-severity PJPPanel on Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV, 2022.

After completing 21 days of therapy, maintenance therapy (secondary prophylaxis) for PJP may be required for children with immune compromise (eg patients with HIV infection or cancer, organ transplant recipients).