Pneumocystosis: treatment

Etiotropic treatment of pneumocystosis

Treatment of pneumocystosis in children without immunodeficiency states is currently the administration of trimethoprim / sulfamethoxazole (120 mg four times a day), more often in combination with furazolidone (one tablet four times a day) or trichopole (four tablets per day) in for 1-2 weeks.

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

[1], [2], [3], [4], [5], [6]

Basic mode

• Trimethoprim / sulfamethoxazole is prescribed from the calculation of trimethoprim (15-20 mg / kg per day) or from the calculation of sulfamethoxazole (75-80 mg / kg per day) or intravenously drip for 21 days. The daily dose is divided into four doses.
• After a two-week admission, it is necessary to carry out a control study of peripheral blood: the development of severe disorders shows the appointment of folic acid preparations.

[7], [8], [9], [10], [11]

Alternative treatment of pneumocystosis

Clindamycin for 600 mg every 8 hours intravenously drip or 300-450 mg every 6 hours inwards, along with an initial 30 mg per day inside for 21 days.

[12], [13], [14], [15], [16], [17], [18],

Pathogenetic treatment of pneumocystis

Pathogenetic treatment of pneumocystis is directed mainly to improving respiratory and cardiovascular activity, it should be intensive in the development of respiratory failure, pulmonary edema, acute pulmonary-cardiac failure.

If the patient has respiratory insufficiency, the appointment of glucocorticoids is indicated: prednisolone at 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 treatment.

The ventilation is performed according to the indications, under suitable conditions.

Clinical examination

All patients with HIV infection are subject to follow-up. The relapse of pneumocystis pneumonia is the prevention of relapse and antiretroviral therapy.

[19], [20], [21], [22], [23], [24], [25]

Prevention of pneumocystis

Nonspecific prophylaxis of pneumocystosis

According to the current recommendations for the prevention of pneumocystis, periodic check-ups of medical personnel working in organ transplantation centers, oncology and hematology units, rehabilitation departments of hospitals, children's closed institutions, and the presence of pneumocystosis markers are necessary to limit nosocomial infection. In addition, it is necessary to disconnect patients as much as possible, to hospitalize patients with pneumocystis pneumonia in the box or separate room. To strengthen the sanitary and hygienic regime, to conduct current and final disinfection in the offices (wet cleaning, treatment of objects with 0.5% chloramine solution, ventilation, ultraviolet irradiation): medical personnel should use masks correctly.

Specific prophylaxis of pneumocystosis

Chemoprophylaxis of PCP is performed in patients with HIV infection with CD4 + -Lymphocyte count below 0.2x10 ⁹ / L (preventive therapy) and in patients who have sustained pneumocystis pneumonia (relapse prevention).

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

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

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