ECIL guidelines for treatment of Pneumocystis jirovecii pneumonia in non-HIV-infected haematology patients

The initiation of systemic antimicrobial treatment of Pneumocystis jirovecii pneumonia (PCP) is triggered by clinical signs and symptoms, typical radiological and occasionally laboratory findings in patients at risk of this infection. Diagnostic proof by bronchoalveolar lavage should not delay the s...

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Bibliographic Details
Published inJournal of antimicrobial chemotherapy Vol. 71; no. 9; pp. 2405 - 2413
Main Authors Maschmeyer, Georg, Helweg-Larsen, Jannik, Pagano, Livio, Robin, Christine, Cordonnier, Catherine, Schellongowski, Peter
Format Journal Article
LanguageEnglish
Published England 01.09.2016
Subjects
Administration, Intravenous
Antifungal Agents - administration & dosage
Clindamycin - administration & dosage
Hematologic Neoplasms - complications
Humans
Pneumocystis carinii - drug effects
Pneumonia, Pneumocystis - drug therapy
Primaquine - administration & dosage
Trimethoprim, Sulfamethoxazole Drug Combination - administration & dosage
Online AccessGet full text
ISSN0305-7453
1460-2091
1460-2091
DOI10.1093/jac/dkw158

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Abstract The initiation of systemic antimicrobial treatment of Pneumocystis jirovecii pneumonia (PCP) is triggered by clinical signs and symptoms, typical radiological and occasionally laboratory findings in patients at risk of this infection. Diagnostic proof by bronchoalveolar lavage should not delay the start of treatment. Most patients with haematological malignancies present with a severe PCP; therefore, antimicrobial therapy should be started intravenously. High-dose trimethoprim/sulfamethoxazole is the treatment of choice. In patients with documented intolerance to this regimen, the preferred alternative is the combination of primaquine plus clindamycin. Treatment success should be first evaluated after 1 week, and in case of clinical non-response, pulmonary CT scan and bronchoalveolar lavage should be repeated to look for secondary or co-infections. Treatment duration typically is 3 weeks and secondary anti-PCP prophylaxis is indicated in all patients thereafter. In patients with critical respiratory failure, non-invasive ventilation is not significantly superior to intubation and mechanical ventilation. The administration of glucocorticoids must be decided on a case-by-case basis.
AbstractList The initiation of systemic antimicrobial treatment of Pneumocystis jirovecii pneumonia (PCP) is triggered by clinical signs and symptoms, typical radiological and occasionally laboratory findings in patients at risk of this infection. Diagnostic proof by bronchoalveolar lavage should not delay the start of treatment. Most patients with haematological malignancies present with a severe PCP; therefore, antimicrobial therapy should be started intravenously. High-dose trimethoprim/sulfamethoxazole is the treatment of choice. In patients with documented intolerance to this regimen, the preferred alternative is the combination of primaquine plus clindamycin. Treatment success should be first evaluated after 1 week, and in case of clinical non-response, pulmonary CT scan and bronchoalveolar lavage should be repeated to look for secondary or co-infections. Treatment duration typically is 3 weeks and secondary anti-PCP prophylaxis is indicated in all patients thereafter. In patients with critical respiratory failure, non-invasive ventilation is not significantly superior to intubation and mechanical ventilation. The administration of glucocorticoids must be decided on a case-by-case basis.The initiation of systemic antimicrobial treatment of Pneumocystis jirovecii pneumonia (PCP) is triggered by clinical signs and symptoms, typical radiological and occasionally laboratory findings in patients at risk of this infection. Diagnostic proof by bronchoalveolar lavage should not delay the start of treatment. Most patients with haematological malignancies present with a severe PCP; therefore, antimicrobial therapy should be started intravenously. High-dose trimethoprim/sulfamethoxazole is the treatment of choice. In patients with documented intolerance to this regimen, the preferred alternative is the combination of primaquine plus clindamycin. Treatment success should be first evaluated after 1 week, and in case of clinical non-response, pulmonary CT scan and bronchoalveolar lavage should be repeated to look for secondary or co-infections. Treatment duration typically is 3 weeks and secondary anti-PCP prophylaxis is indicated in all patients thereafter. In patients with critical respiratory failure, non-invasive ventilation is not significantly superior to intubation and mechanical ventilation. The administration of glucocorticoids must be decided on a case-by-case basis.
The initiation of systemic antimicrobial treatment of Pneumocystis jirovecii pneumonia (PCP) is triggered by clinical signs and symptoms, typical radiological and occasionally laboratory findings in patients at risk of this infection. Diagnostic proof by bronchoalveolar lavage should not delay the start of treatment. Most patients with haematological malignancies present with a severe PCP; therefore, antimicrobial therapy should be started intravenously. High-dose trimethoprim/sulfamethoxazole is the treatment of choice. In patients with documented intolerance to this regimen, the preferred alternative is the combination of primaquine plus clindamycin. Treatment success should be first evaluated after 1 week, and in case of clinical non-response, pulmonary CT scan and bronchoalveolar lavage should be repeated to look for secondary or co-infections. Treatment duration typically is 3 weeks and secondary anti-PCP prophylaxis is indicated in all patients thereafter. In patients with critical respiratory failure, non-invasive ventilation is not significantly superior to intubation and mechanical ventilation. The administration of glucocorticoids must be decided on a case-by-case basis.
Author Cordonnier, Catherine
Robin, Christine
Schellongowski, Peter
Maschmeyer, Georg
Helweg-Larsen, Jannik
Pagano, Livio
Author_xml – sequence: 1
  givenname: Georg
  surname: Maschmeyer
  fullname: Maschmeyer, Georg
  organization: Department of Haematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany
– sequence: 2
  givenname: Jannik
  surname: Helweg-Larsen
  fullname: Helweg-Larsen, Jannik
  organization: Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
– sequence: 3
  givenname: Livio
  surname: Pagano
  fullname: Pagano, Livio
  organization: Institute of Haematology, Università Cattolica del Sacro Cuore, Rome, Italy
– sequence: 4
  givenname: Christine
  surname: Robin
  fullname: Robin, Christine
  organization: Department of Haematology, Assistance Publique-hôpitaux de Paris (APHP), Henri Mondor Teaching Hospital, Créteil, France, University Paris-Est Créteil (UPEC), Créteil, France
– sequence: 5
  givenname: Catherine
  surname: Cordonnier
  fullname: Cordonnier, Catherine
  organization: Department of Haematology, Assistance Publique-hôpitaux de Paris (APHP), Henri Mondor Teaching Hospital, Créteil, France, University Paris-Est Créteil (UPEC), Créteil, France
– sequence: 6
  givenname: Peter
  surname: Schellongowski
  fullname: Schellongowski, Peter
  organization: Department of Medicine I, Intensive Care Unit 13i2, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria, Intensive Care in Hematologic and Oncologic Patients (iCHOP)
BackLink https://www.ncbi.nlm.nih.gov/pubmed/27550993$$D View this record in MEDLINE/PubMed
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Slavin, Monica
Maschmeyer, Georg
Barnes, Rosemary
Groll, Andreas
Rupp, Markus
Lewis, Russell E
Pagano, Livio
Akova, Murat
Mikulska, Malgorzata
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Styczynski, Jan
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Cesaro, Simone
Dalianis, Tina
Brüggemann, Roger
Einsele, Hermann
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Snippet The initiation of systemic antimicrobial treatment of Pneumocystis jirovecii pneumonia (PCP) is triggered by clinical signs and symptoms, typical radiological...
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SubjectTerms Administration, Intravenous
Antifungal Agents - administration & dosage
Clindamycin - administration & dosage
Hematologic Neoplasms - complications
Humans
Pneumocystis carinii - drug effects
Pneumonia, Pneumocystis - drug therapy
Primaquine - administration & dosage
Trimethoprim, Sulfamethoxazole Drug Combination - administration & dosage
Title ECIL guidelines for treatment of Pneumocystis jirovecii pneumonia in non-HIV-infected haematology patients
URI https://www.ncbi.nlm.nih.gov/pubmed/27550993
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