Treatment of Pneumocystis Jiroveci / Pneumocystis Carinii (PCP)

Drugs

Dosing

Remarks

1) TMP/SMX

15-20 mg/kg of TMP
IV in 4 divided doses for 21 days.

Drug of choice Shift to oral administration as soon as clinical improvement occurs.

2) Pentamidine

4 mg/kg/day OD IV for 21 days or shift to
oral Atovaquone after 7-10 days of IV therapy.

Alternative drug if child intolerant to TMP-SMX or no clinical improvement after 5-7 days of TMP-SMX.

3) Atovaquone

30-40 mg/kg/day PO in BD doses for 21 days (max 750 mg/dose. For children between 3-24 months dose of 45 mg/kg/day

Limited data in children
- Alternative therapy.

4) Primaquine / Clindamycin

Primaquine base 0.3 mg/kg OD PO (max 30 mg/day)
                        +
Clindamycin 10 mg/kg IV or PO every 6 hours (max: 600 mg IV, 300-450 mg PO) for 21 days.

Alternative therapy
- Data in children not available

5) Dapsone / Trimethoprim

Dapsone - 2 mg/kg/day OD PO
                        +
Trimethoprim 15 mg/kg/day in 3 divided doses PO for 21 days.

Limited data in children - Alternative therapy.

6) Steroids

Prednisolone
Day 1-5 - 2 mg/kg/ day PO BD
Day 6-10 - 1 mg/kg/day PO
Day 11-12 - 0.5 mg/kg/day PO
                        OR
IV Methyl Prednisolone
Day 1-7 - 1 mg/kg/every 6 hours
Day 8 & 9 - 1 mg/kg every 12 hours Day 10 & 11 - 0.5 mg/kg every 12 hours
Day 12-16 - 1 mg/kg every 24 hours

Indications
- PaO 2 <70 mm of Hg at room air