Treatment: Pneumocystis Infections

• Trimethoprim-sulfamethoxazole (TMP-SMX) for 14-21 days is the regimen of choice for all pts. For doses and adverse effects of TMP-SMX and alternative regimens, see Table 107-1.
• For HIV-infected (and likely all) pts with moderate to severe cases (a room air Pao₂≤70 mmHg or a Pao₂ - Pao₂ gradient ≥35 mmHg), adjunctive glucocorticoids improve the survival rate.
• For pts with HIV infection who present with PCP before the initiation of antiretroviral therapy (ART), ART should usually be started within the first 2 weeks of therapy for PCP.
• Pts typically do not respond to therapy for 4-8 days. Pts whose condition continues to deteriorate after 3-4 days or has not improved after 7-10 days should be reevaluated for other infectious processes and for noninfectious processes (e.g., CHF, pulmonary emboli) that may be causing pulmonary dysfunction.