ECIL guidelines for treatment of Pneumocystis jirovecii pneumonia in non-HIV-infected haematology patients

Georg Maschmeyer, Jannik Helweg-Larsen, Livio Pagano, Christine Robin, Catherine Cordonnier, Peter Schellongowski, Murat Akova, Mahmoud Aljurf, Dina Averbuch, Rosemary Barnes, Ola Blennow, Pierre Yves Bochud, Emilio Bouza, Stéphane Bretagne, Roger Brüggemann, Thierry Calandra, Jordi Carratalà, Simone Cesaro, Catherine Cordonnier, Oliver CornelyTina Dalianis, Rafael De La Camara, Peter Donnelly, Lubos Drgona, Rafael Duarte, Hermann Einsele, Dan Engelhard, Christopher Fox, Corrado Girmenia, Andreas Groll, Dag Heldal, Jannick Helweg-Larsen, Raoul Herbrecht, Hans Hirsch, Elizabeth Johnson, Galina Klyasova, Minna Koskuenvo, Katrien Lagrou, Russell E. Lewis, Per Ljungman, Johan Maertens, Georg Maschmeyer, Malgorzata Mikulska, Marcio Nucci, Christophe Padoin, A. L.L.W. Dwe, Antonio Pagliuca, Zdenek Racil, Patricia Ribaud, Christine Rinaldo, Valérie Rizzi-Puechal, Emmanuel Roilides, Christine Robin, Montserrat Rovira, Markus Rupp, Sonia Sanchez, Peter Schellongowski, Peter Sedlacek, Janos Sinko, Monica Slavin, Isabella Sousa Ferreira, Jan Styczynski, Frederic Tissot, Claudio Viscoli, Katherine Ward, Anne Therese Witschi

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68 Citations (Scopus)

Abstract

The initiation of systemic antimicrobial treatment of Pneumocystis jirovecii pneumonia (PCP) is triggered by clinical signs and symptoms, typical radiological and occasionally laboratory findings in patients at risk of this infection. Diagnostic proof by bronchoalveolar lavage should not delay the start of treatment. Most patients with haematological malignancies present with a severe PCP; therefore, antimicrobial therapy should be started intravenously. High-dose trimethoprim/sulfamethoxazole is the treatment of choice. In patients with documented intolerance to this regimen, the preferred alternative is the combination of primaquine plus clindamycin. Treatment success should be first evaluated after 1 week, and in case of clinical non-response, pulmonary CT scan and bronchoalveolar lavage should be repeated to look for secondary or co-infections. Treatment duration typically is 3 weeks and secondary anti-PCP prophylaxis is indicated in all patients thereafter. In patients with critical respiratory failure, non-invasive ventilation is not significantly superior to intubation and mechanical ventilation. The administration of glucocorticoids must be decided on a case-by-case basis.

Original languageEnglish
Pages (from-to)2405-2413
Number of pages9
JournalJournal of Antimicrobial Chemotherapy
Volume71
Issue number9
DOIs
Publication statusPublished - 1 Sep 2016

Bibliographical note

Publisher Copyright:
© 2016 The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

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