Pneumocystosis - Treatment

Etiotropic treatment of pneumocystosis

Treatment of pneumocystosis in children without immunodeficiency states currently consists of prescribing trimethoprim/sulfamethoxazole (120 mg four times a day), often in combination with furazolidone (one tablet four times a day) or trichopolum (four tablets a day) for 1-2 weeks.

Treatment of pneumocystosis in AIDS patients must be combined with pathogenetic and symptomatic treatment, as well as with antiretroviral therapy, which is prescribed during the recovery period after pneumocystis pneumonia.

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Basic mode

• Trimethoprim/sulfamethoxazole is prescribed based on trimethoprim (15-20 mg/kg per day) or based on sulfamethoxazole (75-80 mg/kg per day) orally or intravenously by drip for 21 days. The daily dose is divided into four doses.
• After two weeks of treatment, it is necessary to conduct a control study of peripheral blood: if severe disorders develop, the administration of folic acid preparations is indicated.

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Alternative treatment for pneumocystis

Clindamycin 600 mg every 8 hours intravenously by drip or 300-450 mg every 6 hours orally together with primaquine 30 mg per day orally for 21 days.

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Pathogenetic treatment of pneumocystosis

Pathogenetic treatment of pneumocystosis is aimed mainly at improving respiratory and cardiovascular activity; it should be intensive in the development of respiratory failure, pulmonary edema, and acute pulmonary heart failure.

If the patient has respiratory failure, glucocorticoids are indicated: prednisolone 80 mg per day (40 mg twice) for 5 days, then 40 mg once a day for 5 days, then 20 mg per day until the end of the course of treatment.

Artificial ventilation is performed according to indications and when suitable conditions exist.

Clinical examination

All patients with HIV infection are subject to dispensary observation. Those who have had pneumocystis pneumonia are given relapse prevention and antiretroviral therapy.

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Prevention of pneumocystosis

Nonspecific prevention of pneumocystis

According to current recommendations for the prevention of pneumocystis, it is necessary to conduct periodic checks of medical personnel working in organ transplant centers, oncology and hematology departments, rehabilitation departments of hospitals, and closed children's institutions for the presence of pneumocystis markers in order to limit nosocomial infection. In addition, it is necessary to isolate patients as much as possible, hospitalize patients with pneumocystis pneumonia in a box or a separate ward, strengthen the sanitary and hygienic regime, conduct current and final disinfection in departments (wet cleaning, treatment of objects with a 0.5% chloramine solution, ventilation, ultraviolet irradiation): medical personnel must use masks correctly.

Specific prophylaxis of pneumocystosis

Chemoprophylaxis of Pneumocystis pneumonia is performed in patients with HIV infection with a CD4+ lymphocyte count below 0.2x10 ⁹ /l (preventive therapy) and in patients who have had Pneumocystis pneumonia (prevention of relapse).

For prevention, trimethoprim + sulfamethoxazole is used at 960 mg once a day. As an alternative regimen, this drug can be used three times a week (three days in a row) two tablets once a day.

Primary prevention of pneumocystosis and prevention of relapses is stopped with a persistent increase in the number of CD4+ lymphocytes - above 0.2x10 ⁹ /l for 3 months.

Treatment of pneumocystosis is resumed when signs of disease activation appear.