A. Trimethoprim-sulfamethoxazole DS (Bactrim DS, Septra DS) is the recommended initial therapy for PCP. Dosage is 15-20 mg/kg/day of TMP IV divided q6h for 14-21 days. Adverse effects include rash (33%), elevation of liver enzymes (44%), nausea and vomiting (50%), anemia (40%), creatinine elevation (33%), and hyponatremia (94%).
B. Pentamidine is an alternative in patients who have adverse reactions or fail to respond to TMP-SMX. The dosage is 4 mg/kg/day IV for 14-21 days. Adverse effects include anemia (33%), creatinine elevation (60%), LFT elevation (63%), and hyponatremia (56%). Pancreatitis, hypo-glycemia, and hyperglycemia are common side effects.
C. Corticosteroids. Adjunctive corticosteroid treatment is beneficial with anti-PCP therapy in patients with a partial pressure of oxygen (PaO2) less than 70 mm Hg, (A-a)DO2 greater than 35 mm Hg, or oxygen saturation less than 90% on room air. Contraindications include suspected tuberculosis or disseminated fungal infection. Treatment with methyl-prednisolone (SoluMedrol) should begin at the same time as anti-PCP therapy. The dosage is 30 mg IV q12h x 5 days, then 30 mg IV qd x 5 days, then 15 mg qd x 11 days OR prednisone, 40 mg twice daily for 5 days, then 40 mg daily for 5 days, and then 20 mg daily until day 21 of therapy.
Was this article helpful?