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Review
. 2021 Oct 29;8(12):ofab545.
doi: 10.1093/ofid/ofab545. eCollection 2021 Dec.

On the Treatment of Pneumocystis jirovecii Pneumonia: Current Practice Based on Outdated Evidence

Emily G McDonald  1   2 , Guillaume Butler-Laporte  3 , Olivier Del Corpo  4 , Jimmy M Hsu  4 , Alexander Lawandi  5 , Julien Senecal  4 , Zahra N Sohani  6 , Matthew P Cheng  7   8 , Todd C Lee  2   3   8
Affiliations
Review

On the Treatment of Pneumocystis jirovecii Pneumonia: Current Practice Based on Outdated Evidence

Emily G McDonald et al. Open Forum Infect Dis. .

Abstract

Pneumocystis jirovecii pneumonia (PCP) is a common opportunistic infection causing more than 400000 cases annually worldwide. Although antiretroviral therapy has reduced the burden of PCP in persons with human immunodeficiency virus (HIV), an increasing proportion of cases occur in other immunocompromised populations. In this review, we synthesize the available randomized controlled trial (RCT) evidence base for PCP treatment. We identified 14 RCTs that were conducted 25-35 years ago, principally in 40-year-old men with HIV. Trimethoprim-sulfamethoxazole, at a dose of 15-20 mg/kg per day, is the treatment of choice based on historical practice rather than on quality comparative, dose-finding studies. Treatment duration is similarly based on historical practice and is not evidence based. Corticosteroids have a demonstrated role in hypoxemic patients with HIV but have yet to be studied in RCTs as an adjunctive therapy in non-HIV populations. The echinocandins are potential synergistic treatments in need of further investigation.

Keywords: HIV; Pneumocystis jirovecii pneumonia; TMP-SMX; immunosuppressed; opportunistic infectious.

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Figures

Figure 1.
Figure 1.
PRISMA diagram.
Figure 2.
Figure 2.
Trimethoprim sulfamethoxazole (TMP-SMX) vs comparators: treatment failure.
Figure 3.
Figure 3.
Trimethoprim sulfamethoxazole (TMP-SMX) vs comparators: overall mortality.
Figure 4.
Figure 4.
Trimethoprim sulfamethoxazole (TMP-SMX) vs comparators: change of treatment due to toxicity.
See this image and copyright information in PMC

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