skip to main content

PJP Co-trimoxazole Intolerant — SCE Infectious Diseases MCQ

Instant feedback + full explanation. One question, done properly.

ModerateHIV MedicinePJP Co-trimoxazole IntolerantSCE Infectious Diseases

A 45-year-old man with HIV develops Pneumocystis jirovecii pneumonia. He is intolerant of Co-trimoxazole (severe rash and hepatotoxicity on two attempts). He has moderate-severe disease (PaO2 8.5 kPa on air). What is the best alternative treatment?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — IV Pentamidine 4 mg/kg daily for 21 days plus adjunctive Prednisolone

For moderate-severe PJP (PaO2 <9.3 kPa) with Co-trimoxazole intolerance, IV Pentamidine is the recommended second-line agent. Atovaquone and Clindamycin/Primaquine are suitable for mild PJP only (oral options). Dapsone/Trimethoprim is an alternative for mild disease. Echinocandins (Caspofungin) have activity against PJP cyst forms but not trophozoites — they are not standard monotherapy. Adjunctive Prednisolone is indicated regardless of the antimicrobial chosen when PaO2 <9.3 kPa.

Reference: BHIVA 2022 – OI guidelines; BTS 2020 – PJP management