Treatment of PCP

Consult expert advice.

All patients suspected of having PCP should be treated, as early treatment improves outcome, without impairing diagnostic tests.

Treatment should match the patient's clinical condition, with the patient managed as an out-patient if possible.

First-line treatment:

• a clinical evidence review states that beneficial options for first-line treatment of PCP are (1):
  • atovaquone or,
  • clindamycin–primaquine or,
  • pentamidine (aerosolised) or,
  • pentamidine (intravenous) or,
  • trimethoprim–dapsone or,
  • trimethoprim–sulfamethoxazole (co-trimoxazole)
• also there is evidence of benefit adjuvant corticosteroids for moderate to severe PCP

Notes:

• IV co-trimoxazole
  • side-effects are however severe: most experience nausea and some develop intractable vomiting. There may also be skin rashes, neutropenia, thrombocytopenia and hepatitis
  • 25% of patients will require alternative therapy
• pentamidine IV
  • note that pentamidine however has serious adverse effects including cardiac arrhythmias, hypotension, pancreatitis, thrombocytopaenia, neutropaenia, hypoglycaemia, hypocalcaemia and acute renal failure and should be monitored carefully
• atovaquone (BW566 C80 - a hydroxy napththoquinone)
  • side-effects: fever, vomiting, diarrhoea, insomnia, rash, abnormal LFTs; interactions include: rifampicin, zidovudine, metoclopramide

Reference:

1. Clinical Evidence. BMJ March 2006.
2. Adler MW (Ed); ABC of AIDS 4th Ed (1997) BMJ Publishing Group ISBN 0-7279-1137-6.