TABLE 1.
Treatment of P. cariniia
| Agent(s) (route)b | Dose | Options or commentsb |
|---|---|---|
| First line: TMP-SMX (i.v. or p.o.) | 15–20 mg of TMP/kg/day and 75–100 mg of SMX/kg/day | Treat through rash with reduced dose; desensitize |
| Second line | ||
| Dapsone (p.o.) with TMP (p.o. or i.v.) | 100 mg of dapsone/day and 15–20 mg of TMP/kg/day | Side effects include methemoglobinemia and glucose-6-phosphate dehydrogenase deficiency; may be tolerated in patients with sulfa drug allergy |
| Atovaquone (p.o.) | 750 mg of liquid p.o. t.i.d. | Variable absorbance; absorbance is improved with fatty food; few side effects |
| Pentamidine isethionate (i.v.) | 4 mg/kg/day; 300 mg/day maximum | Lower dose (2–3 mg/kg may be used); intramuscular administration not advised |
| Third line | ||
| Trimetrexate (i.v.) with folinic acid | 30–45 mg of trimetrexate/m2/day with 80–100 mg of folinic acid/m2day | Efficacy equal to that of pentamidine; anemia, marrow toxicity; early relapse |
| Clindamycin (i.v. or p.o.) and primaquine | 450–600 mg of clindamycin every 6 h and 15–30 mg of primaquine base once a day | Side effects include methemoglobinemia and diarrhea (may substitute pyrimethamine for primaquine) |
| Others | ||
| Pyrimethamine (p.o.) with sulfadiazine (p.o.) | Load of 50 mg of pyrimethamine b.i.d. for 2 days and then 25–50 mg q.d., load of 75 mg/kg of sulfadiazine and then 100 mg/kg/day | Not studied fully; maximum of 4 g of sulfadiazine in two doses (up to 8 g total) |
| Pyrimethamine-sulfadoxine | Not standardized | Long half-life; should not be used in patients with sulfa drug allergy |
| Piritrexim-folinic acid | Under study | Like trimetrexate |
| 8-Aminoqunoline | Under study | |
| Macrolides and sulfonamides | Under study | Synergy; macrolides alone are inactive |
a
Adjunctive therapies (see text) include corticosteroids (high dose with rapid taper), possibly gamma interferon, and GM-CSF. Abbreviations: i.v., intravenous; p.o., oral; t.i.d., three times a day; q.d., once a day; b.i.d., twice a day.