This handout is for pneumocystis (jirovecii) pneumonia. Your care team identified this based on: subacute progressive dyspnea + dry non-productive cough ± low-grade fever, often with marked exertional desaturation, in an immunocompromised host (nih/cdc oi 2025).
Other reasons your team may use this plan: bilateral perihilar / diffuse ground-glass opacities on hrct (hrct ggo lr+ high in the right host; near-perfect negative predictive value if hrct normal) (nih/cdc oi 2025); elevated ldh (often >500 u/l) — sensitive but non-specific; tracks burden/response (nih/cdc oi 2025); elevated serum (1→3)-β-d-glucan in an immunocompromised host (sens ~91%; interpret post-test conditional on host pretest band — del corpo cmi 2020 pmid 32479781).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| sulfamethoxazole/trimethoprim | 15-20 mg/kg/day TMP component PO ÷ q8h (≈ 2 DS tablets PO TID for a 70-kg adult) | PO | q8h × 21 days (HIV) | NIH/CDC OI 2025 — TMP-SMX is first-line for PJP at every severity; the combination MIN, not single-ingredient. RxCUI 10831 = sulfamethoxazole/trimethoprim RxNav-verified MIN 2026-05-16 (was 10180 sulfamethoxazole-alone — corrected). |
| atovaquone | 750 mg PO BID with a fatty meal | PO | q12h × 21 days | NIH/CDC OI 2025 — mild HIV-PJP only; less effective than TMP-SMX, requires fatty food for absorption. RxCUI 60212 RxNav-verified IN 2026-05-16. |
| dapsone | Dapsone 100 mg PO daily + trimethoprim 5 mg/kg PO q8h (combination) | PO | daily / q8h × 21 days | NIH/CDC OI 2025; Safrin ACTG 108 (PMID 8610948) — dapsone-TMP comparable to TMP-SMX in mild-moderate. SCREEN G6PD first (hemolysis); dapsone-class cross-reactivity caveat in severe sulfonamide hypersensitivity. RxCUI 3108 = dapsone RxNav-verified IN 2026-05-16 (prior notes referenced 3008 = cyclosporine — SAFETY-CRITICAL correction). |
Plan: PJP empirical regimen — severity tier × host class × sulfa-allergy / G6PD branching (NIH/CDC OI 2025)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Secondary prophylaxis (TMP-SMX SS daily) until immune reconstitution — HIV: CD4 >200 ×3 mo on ART (consider stop at CD4 100-200 if VL suppressed ≥3-6 mo); non-HIV: until immunosuppression resolved. Initiate/optimize ART within 2 weeks of PJP treatment in HIV (early ART reduces progression/death — Zolopa ACTG A5164 PMID 19440326); monitor IRIS; minimize/taper the iatrogenic immunosuppressant where feasible (NIH/CDC OI 2025)
Guideline: 2025 NIH/CDC/HIVMA-IDSA Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults & Adolescents with HIV — Pneumocystis section (clinicalinfo.hiv.gov, updated through Dec 2025; WebSearch-verified current 2026-05-16) + Bozzette/California Collaborative NEJM 1990 (adjunctive steroids) + non-HIV PJP literature (Cilloniz Expert Rev Anti Infect Ther 2019)