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PJP — SCE Infectious Diseases MCQ

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EasyHIV MedicinePJPSCE Infectious Diseases

A 41-year-old man with HIV (CD4 120 cells/µL) presents with 2 weeks of progressive dyspnoea and dry cough. Chest X-ray shows bilateral perihilar ground-glass opacification. SpO2 is 88% on room air. Induced sputum confirms Pneumocystis jirovecii. What is the most appropriate treatment?

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Correct answer: E — Co-trimoxazole 120 mg/kg/day IV in divided doses plus prednisolone

This patient has moderate-severe PJP (PaO2 <9.3 kPa/SpO2 <92% on air). High-dose IV Co-trimoxazole (120 mg/kg/day in divided doses) is first-line treatment. Adjunctive corticosteroids (prednisolone 40 mg BD for 5 days, then taper over 21 days) are indicated when PaO2 <9.3 kPa on air, as they reduce mortality. Atovaquone is only for mild disease. Pentamidine IV is second-line if co-trimoxazole is contraindicated.

Reference: BHIVA 2022 – Guidelines on treatment of opportunistic infections in HIV; BTS 2020 – Management of PJP