Alternative treatment for adults with low- to moderate-severity PJP

For adults with low- to moderate-severity PJP who have nonsevere hypersensitivity 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, 8-hourly for 21 days clindamycin clindamycin clindamycin

PLUS

primaquine 30 mg orally, daily for 21 days primaquine primaquine primaquine

OR

1dapsone 100 mg orally, daily for 21 days1. For dosage adjustment in adults with kidney impairment, see dapsone dosage adjustment dapsone dapsone dapsone

PLUS

trimethoprim 5 mg/kg up to 450 mg orally, 8-hourly for 21 days. For dosage adjustment in adults with kidney impairment, see trimethoprim dosage adjustment trimethoprim trimethoprim trimethoprim

OR as a single drug

2atovaquone 750 mg orally with fatty food or full-fat milk, 12-hourly for 21 days. atovaquone atovaquone atovaquone

Test for glucose-6-phosphate dehydrogenase (G6PD) deficiency before starting treatment with primaquine or dapsone – seek expert advice if the patient is G6PD deficient.

For adults with severe2 hypersensitivity to trimethoprim+sulfamethoxazole, use clindamycin plus primaquine, or atovaquone alone (see dosages above). Do not use dapsone because there is a possibility of cross-reactivity between dapsone and sulfamethoxazole.

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

1 The cross-reactivity rate between dapsone and sulfamethoxazole is approximately 9 to 12%; do not use dapsone in patients with severe hypersensitivity (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN]; see Definition of commonly used antimicrobial hypersensitivity terms).Return
2 Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse. 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