Table 34-10.

Treatment Schedules for Pneumocystis jirovecii Pneumonia

Drug	Dosage	Notes
Trimethoprim-sulfamethoxazole	Trimethoprim 20 mg/kg iv q24h and sulfamethoxazole 100 mg/kg iv q24h in 2–3 divided doses for 3 days then reduced to trimethoprim 15 mg/kg iv q24h and sulfamethoxazole 75 mg/kg iv. q24h in 2–3 divided doses for 18 further days Same daily doses of trimethoprim-sulfamethoxazole po q24h, in 3 divided doses for 21 days 1920 mg (2 trimethoprim-sulfamethoxazole double strength tablets) po q8h for 21 days	Dilute 1:25 in 0.9% saline infused over 90–120 min
Clindamycin-primaquine	Clindamycin 600–900 mg iv q6h or q8h iv and primaquine 15–30 mg po q24h for 21 days	Methemoglobinemia Less likely if dose of 15 mg po q24h of primaquine is used
	Clindamycin 300–450 mg po q6h to q8h and primaquine 15–30 mg po q24h for 21 days
Pentamidine	4 mg/kg iv q24h for 21 days	Dilute in 250 mL 5% dextrose in water and infuse over 60 min
Trimethoprim-dapsone	Trimethoprim 20 mg/kg po q24h in 3 divided doses and dapsone 100 mg po q24h for 21 days
Trimetrexate-folinic acid	45 mg/m2 or 1.2 g/kg iv q24h for 21 days with folinic acid 20 mg/m2 or 0.5 mg/kg q6h for 24 days	Folinic acid must be continued for 3 days after last dose of trimetrexate
Atovaquone	750 mg po q12h for 21 days	Give with food to increase absorption
Glucocorticoids Prednisolone	40 g po q12h, days 1–5 40 g po q24h, days 6–10 20 g po q24h, days 11–21	Regimen recommended by CDC/NIH/IDSA, widely used in USA
Methylprednisolone	iv at 75% of dose given above for prednisolone
Methylprednisolone Prednisolone	1 iv q24h, days 1–3 0.5 iv days 4–6 then 40 g po q24h reducing to 0, days 7–16	Regimen widely used in United Kingdom

NB, None of these regimens for adjuvant glucocorticoid therapy have been compared in prospective clinical trials.