Pneumocystis Jiroveci Pneumonia (PCP)

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An opportunistic infection caused by Pneumocystis jiroveci. Patients present with progressive shortness of breath and possibly cyanosis with few or no chest signs.

Manage with:

Medicine	Adult dose	Frequency	Duration
Cotrimoxazole po	1920mg (4 tabs)	3 times a day	21 days

For infant or child over 1 month:

10mg/kg every 12 hours for 21 days. Total daily dose may alternatively be given in 3-4 divided doses orally.

If they are allergic, try cotrimoxazole desensitisation

• or in sulphonamide allergy:

	Medicine	Adult dose	Frequency	Duration
	clindamycin po	450-600mg	6 hourly	21 days
and	primaquine po	30mg	once a day

• If any tachypnoea or cyanosis is present, add:

	Medicine	Adult dose	Frequency	Duration
	prednisolone po	40mg	twice a day	5 days
then	prednisolone po	40mg	once a day	5 days
then	prednisolone po	20mg	once a day	11 days

High flow oxygen and nursed propped up are key in treatment of severe PCP

After PCP has been treated give cotrimoxazole prophylaxis until immunity is restored. (Follow current ART Guidelines). This also applies to any other patients with AIDS defining disease.

If still no response, consider malignancy, for example, Kaposi's sarcoma.