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Pneumocystis Prophylaxis

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Pneumocystis Prophylaxis, Pneumocystis Jiroveci Prophylaxis, PCP Prophylaxis

  • See Also
  1. Pneumocystis carinii (Pneumocystis jiroveci)
  • Indications
  • Start prophylaxis
  1. CD4 Count < 200
  2. Constitutional symptoms regardless of CD4 Count
    1. Oral Candidiasis (Thrush)
    2. Unexplained fever > 2 weeks
  3. Prior history of Pneumocystis
    1. Second episode PCP Pneumonia within 1 year: 30-60%
  • Indications
  • Stop prophylaxis
  1. CD4 Count > 200 (stable for at least 3 months) and
  2. Triple Antiretroviral therapy >6 months
  3. Also applies to MAC, Cryptococcus, Toxoplasmosis
  4. References
    1. (2002) Ann Intern Med 137(4): 239-250 [PubMed]
  • Efficacy
  1. Bactrim daily is extremely effective in preventing PCP
  2. Also decreases the Incidence of Bacterial Infections
  3. Decreases the Incidence of ToxoplasmosisEncephalitis
    1. Patients with previous Toxoplasmosis infection
  • Dosing
  • First line
  1. Trimethoprim-sulfamethoxazole (TMP-SMZ, Bactrim, Septra) DS daily
    1. More effective then other measures when CD4 < 200
    2. Prevents first and recurrent episodes of Pneumocystis
  • Dosing
  • Other agents
  1. Aerosolized Pentamidine
    1. Adults: 300 mg every 4 weeks reduces the risk of PCP by 60-80%
    2. Well tolerated (cough and bronchospasm in 50% of patients)
  2. Dapsone 100 mg PO qd
    1. Add Pyrimethamine for Toxoplasmosis coverage
    2. Screen for G6PD prior to use
  • Adverse Effects
  1. Significantly reduced adverse effects with Bactrim SS
    1. Bactrim DS no more effective than Bactrim SS
    2. Reference
      1. Schneider (1995) J Infect Dis 171:1632-6 [PubMed]
  2. Adverse reactions to Bactrim in >3 months of use
    1. Requires discontinuation in 25% of patients