Pneumocystis Pneumonia

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ICD10 CODE: B59

Interstitial pneumonitis caused by the parasite Pneumocystis jirovecii (formerly carinii). It is common in severely immunosuppresed patients (e.g. in HIV).

Clinical features

  • Fever
  • Dry cough
  • Shortness of breath (significant hypoxemia)

Investigations

  • Chest x-ray shows characteristic bilateral interstitial infiltrates

Management

Pre-emptive treatment for cryptococcal disease

TREATMENT LOC
Pneumocystis Jirovecii pneumonia
  • Give oxygen if SpO2 <94%
  • Cotrimoxazole 120 mg/kg/daily in 2-4 divided doses for 21 days
- For example cotrimoxazole 480 mg tablets:
- If patient is < 60 kg: give 3 tablets If patient >60 kg: give 4 tablets
  • Plus prednisolone 2 mg/kg daily in 3 divided doses for 5 days, then reduce dose to complete 21 days of treatment

Or (in patients who cannot tolerate or do not respond to cotrimoxazole)

  • Pentamidine 4 mg/kg by IV infusion daily for 21 day

- Reduce dose in renal impairment

- Avoid direct bolus injections whenever possible but if unavoidable, never give rapidly
Alternative regimen (21-day course) if above not avail- able/ tolerated
- Clindamycin 600 mg every 8 hours
- Plus dapsone 100 mg daily

HC4

RRH
 

Prophylaxis
Give to all patients with history of PCP infection and consider also for severely immunocompromised patients
- Cotrimoxazole 960 mg daily

or
- Dapsone 100 mg daily
- Continue until immunity recovers sufficiently