Maintenance therapy for PJP in patients with hypersensitivity to trimethoprim+sulfamethoxazole
Alternatives for maintenance therapy for PJP are less effective than trimethoprim+sulfamethoxazole.
Assess patients with PJP who report hypersensitivity to trimethoprim+sulfamethoxazole:
- for adults, see Clinical history for initial assessment of adults reporting trimethoprim+sulfamethoxazole hypersensitivity
- for children, seek expert advice.
Desensitisation is an option for clinically stable patients who report hypersensitivity to trimethoprim+sulfamethoxazole – seek expert advice if desensitisation is being considered. Do not desensitise patients:
- with severe delayed1 hypersensitivity
- in whom adherence to therapy is unlikely – if 1 day of therapy is missed, the patient’s hypersensitivity will return and desensitisation must be performed again.
Following trimethoprim+sulfamethoxazole desensitisation, use the daily regimen of trimethoprim+sulfamethoxazole rather than the twice- or 3-times-weekly regimensLiu 2011.
If desensitisation is not an option, see the alternative maintenance therapy options for PJP in adults or children.
Note: Assess patients reporting hypersensitivity to trimethoprim+sulfamethoxazole.
1 Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return