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Adult Pediatric All

Criteria & Principles

Pneumocystis jirovecii is an opportunistic fungus that causes pneumonia in immunocompromised hosts. Effective prophylaxis significantly decreases the incidence of Pneumocystis jirovecii pneumonia (PJP) in susceptible hosts including, but not limited to, the following:

  • People living with HIV (PLWH)
  • Solid organ transplant recipients
  • Patients with malignancy
  • Patients receiving high-dose corticosteroid treatment (equivalent to ≥20 mg of prednisone daily for ≥1 month)
  • Select patients with multiple causes of immunodeficiency and/or receiving multiple immune-modulating agents

Although not discussed here, infectious diseases (ID) or transplant ID consultation is recommended for the treatment of PJP.

PJP prophylaxis agents:

PREFERRED: trimethoprim/sulfamethoxazole (TMP/SMX)

ALTERNATIVES (in order of preference; however, choice of agent may depend upon patient-specific factors):

  1. atovaquone 1500mg PO daily
  2. dapsone 100mg PO daily (check G6PD prior to initation)
  3. pentamidine 300mg inhalation once every 28 days

PJP Prophylactic Agent Considerations

Duke University Hospital (DUH) PJP prophylaxis recommendations can be found at the corresponding links:

1) Hematology/oncology (e.g. acute lymphoblastic leukemia, lymphoma, CAR-T, multiple myleoma, etc)

2) Adult Stem Cell Transplantation

3) Solid Organ Transplantation -- see Policy Center links below for infection prophylaxis protocols (list not all-inclusive)