8.2.8
Pneumocystis jirovecii pneumonia (PJP)
Clinical HIV Guidelines, 5th Edition, 2022. Chapter 8, HIV-related diseases.
Signs and symptoms
Extreme shortness of breath; dry cough; +/- fever Severe pneumonia in infants <12 months
Investigations
O2 saturation: hypoxia, drop on exertion CXR: Diffuse interstitial or hyperinflation; perihilar “batwing” infiltrates Test for COVID-19 Treat empirically for PCP any HIV exposed or confirmed infected infant presenting with severe pneumonia.
Treatment
Admit and give oxygen Cotrimoxazole tablets 960mg Adult: 120mg/kg/day, divided into 3 doses (8-hourly) for 21 days Child: 120mg/kg/day, divided into 3 doses (8-hourly) for 21 days (max 1920mg/day)
Lifelong maintenance (CPT)
IV Cotrimoxazole if unable to swallow and NGT impossible to place Prednisolone 5mg tablets Give only if patient is hypoxic / in respiratory distress Give 15-30 minutes before cotrimoxazole Adult: 8 tablets 12-hourly for 5 days, then 8 tablet 24-hourly for 5 days, then 4 tablets 24-hourly for 11 days Child: 2mg/kg 24-hourly for 7 days, then 1mg/kg 24-hourly for 7 days, then 0.5mg/kg 24-hourly for 7 days Secondary management Clindamycin 600mg 8-hourly for 21 days + Primaquine 30mg 24-hourly for 21 days HIV-related diseases
Check doses against the printed guideline and your clinical judgement before treating a patient. Spotted an error? Report it from the contact links below.
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