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. 2009 Sep 9;15(10):1143–1238. doi: 10.1016/j.bbmt.2009.06.019

Pathogen: Pneumocystis jiroveci

Indication First Choice Alternatives
  • Prophylaxis among
    • a) all allogeneic HCT recipients (AII); or
    • b) autologous HCT recipients with underlying hematologic malignancies, those receiving intense conditioning regimens or graft manipulation, or those who have recently received purine analogues (BIII) [481]

  • Note: Administer prophylaxis from time of engraftment for at least 6 months after HCT(AII)

  • Note: Continue prophylaxis beyond 6 months (AII) for the duration of immune suppression for all persons who:

  • a) are receiving immunosuppressive therapy (eg, prednisone or cyclosporine); or

  • b) have cGVHD

  • Note: Some researchers also recommend administering prophylaxis for 1-2 weeks before HCT (ie, day –14 to –2) (CIII)

  • Trimethoprim-sulfamethoxazole (AII)

  • Adult/Adolescents:

  • •

    1 double-strength (160/800 mg) tablet orally daily; or

  • •

    1 single-strength (80/400 mg) tablet orally daily; or

  • •

    1 double-strength tablet orally 3 times/week

  • Pediatrics:

  • 150 mg trimethoprim/750 mg

  • sulfamethoxazole/m2/day by

  • mouth as 1 of the following:

  • •

    2 divided doses 3 times/week on consecutive days (AII); or

  • •

    a single dose orally

  • 3 times/week on consecutive

  • days; or

  • •

    2 divided doses daily for 7 days; or

  • •

    2 divided doses 3 times/week on alternate days

  • Adult/Adolescents:

  • Dapsone 50 mg orally 2 times/day; or 100 mg orally daily (CII)

  • Atovaquone 750 mg twice daily or 1500 mg once daily, orally (CII)

  • Pentamidine 300 mg every 3-4 weeks by Respirgard II™ nebulizer (CII)

  • Pediatrics:

  • Dapsone (≥1 month old) 2 mg/kg (maximum dose, 100 mg) orally daily (CII)

  • Atovaquone 15 mg/kg twice daily or 30 mg/kg once daily,orally (CII)

  • Pentamidine IV

  • 4 mg/kg i.v. every 2-4 weeks

  • Pentamidine administered every month by Respirgard II™ nebulizer (CIII)

  • ≤5 years old: 9 mg/kg/dose; or

  • >5 years, 300 mg

HCT indicates hematopoietic cell transplant; cGVHD, chronic graft-versus-host disease.

Notes: Patients who are receiving sulfadiazine-pyrimethamine for toxoplasmosis therapy are protected against Pneumocystis jiroveci and do not need additional prophylaxis.Trimethoprim-sulfamethoxazole is not recommended for patients <2 months old, because of risk for kernicterus.