Corticosteroid therapy for high-severity PJP
For adults and children with high-severity PJP (see Assessment of Pneumocystis jirovecii pneumonia (PJP) disease severity) who have HIV infection, use adjunctive corticosteroid therapy in addition to antimicrobial therapy. Although evidence is lacking, corticosteroids are also often used for adults and children with high-severity PJP who do not have HIV infectionCooley 2014.
When indicated, start corticosteroids as soon as possible. For corticosteroid therapy for high-severity PJP in adults, useEuropean AIDS Clinical Society (EACS) 2022Keighley 2021Panel on Opportunistic infections in HIV-exposed and HIV-infected children 2022:
prednisolone (or prednisone) 40 mg orally (or enterally), 12-hourly for 5 days, then 40 mg daily for 5 days, then 20 mg daily for 11 days or until antibiotic therapy is completed. prednisolone prednisolone prednisolone
For corticosteroid therapy for high-severity PJP in children, usePanel on Opportunistic infections in HIV-exposed and HIV-infected children, 2022:
prednisolone (or prednisone) 1 mg/kg up to 40 mg orally (or enterally), 12-hourly for 5 days, then 1 mg/kg up to 40 mg daily for 5 days, then 0.5 mg/kg up to 20 mg daily for 11 days or until antibiotic therapy is completed. prednisolone
If oral or enteral therapy is not tolerated or there are concerns about absorption, use initially:
1hydrocortisone 100 mg (child: 2 mg/kg up to 100 mg) intravenously, 6-hourly for up to 5 days; see below for advice on further dosing hydrocortisone hydrocortisone hydrocortisone
OR
1methylprednisolone sodium succinate 30 mg (child: 1 mg/kg up to 30 mg) intravenously, 12-hourly for up to 5 days; see below for advice on further dosing. methylprednisolone sodium succinate methylprednisolone methylprednisolone
Once oral therapy is tolerated, switch to oral prednisolone (or prednisone) to complete the 21-day course (intravenous + oral). If the patient is unable to tolerate or absorb oral (or enteral) therapy after 5 days, taper the intravenous dosage; use the prednisolone (or prednisone) dosage schedule as a guide.