II. 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%

III. 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]

IV. 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

V. 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

VI. Dosing: Other agents

  1. Aerosolized Pentamidine
    1. 300 mg q month reduces the risk of PCP by 60-80%
    2. Well tolerated (cough and bronchospasm in 50-66)
  2. Dapsone 100 mg PO qd
    1. Add Pyrimethamine for Toxoplasmosis coverage
    2. Screen for G6PD prior to use

VII. 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

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Ontology: Pneumocystis carinii prophylaxis (C0877620)

Concepts Therapeutic or Preventive Procedure (T061)
English Pneumocystis carinii prophylaxis, Pneumocystis jirovecii prophylaxis
Dutch pneumocystis carinii-profylaxe, profylaxe tegen Pneumocystis jiroveci
French Prophylaxie anti-pneumocystis carinii, Prophylaxie anti-Pneumocystis jirovecii
German Pneumocystis carinii Prophylaxe, Pneumocystis jirovecii-Prophylaxe
Italian Profilassi per Pneumocystis carinii, Profilassi per Pneumocystis jirovecii
Portuguese Profilaxia de Pneumocystis carinii, Profilaxia de Pneumocystis jirovecii
Spanish Profilaxis frente al Pneumocystis carinii, Profilaxis frente al Pneumocystis jirovecii
Japanese ニューモシスティスカリニ感染予防, ニューモシスティスカリニカンセンヨボウ, ニューモシスチス・イロベチイ感染予防, ニューモシスチスイロベチイカンセンヨボウ
Czech Prevence pneumocystózy, Profylaxe proti infekci způsobené Pneumocystis jirovecii
Hungarian Pneumocystis carinii profilaxis, Pneumocystis jirovecii prophylaxis