RTI 5.1 Pneumonia - (fungal) Pneumocystis jirovecii (PJP)

Content version: U-102.2
Updated: 10/20/2025 - 14:41

Recommendations

≥ 18 years

Indications: mild to moderate PJP
	Dosage	Remarks
1st choice	co-trimoxazole (trimethoprim + sulfamethoxazole) 1600/320 mg TDS 21 days	if symptoms are mild, treat orally For weight <50 kg: 1440 mg IV, TDS 21 days
2nd choice	clindamycin IV 600 mg TDS 21 days + primaquine PO 30 mg once daily 21 days	for cotrimoxazole allergy Do not administer primaquine in glucose-6-phosphate dehydrogenase deficiency
2nd choice	dapsone PO 100 mg once daily 21 days + trimethoprim PO 300 mg once daily 21 days	for cotrimoxazole allergy
2nd choice	atovaquone PO 750 mg twice daily 21 days	suspension, take with food

≥ 18 years

Indications: moderate to severe PJP
	Dosage	Remarks
1st choice	co-trimoxazole (trimethoprim + sulfamethoxazole) IV 1920 mg TDS 21 days
2nd choice	clindamycin IV 600 mg TDS 21 days + primaquine PO 30 mg once daily 21 days	For cotrimoxazole allergy Or clindamycin 600 mg PO TDS
2nd choice	pentamidine IV 4 mg/kg once daily 21 days

Comments

If pO2 < 9 kPa add prednisone:

day 1-5 40 mg twice daily;
day 6-10 20 mg twice daily;
day 11-14 20 mg once daily.

After treatment, secondary prophylaxis.