The most effective treatment for PCP is a combination of two drugs: trimethoprim and sulfamethoxazole (TMP-SMX; Bactrim™, Septra®). Dosages for both drugs are lower today than they were ten years ago. These drugs can be taken either by mouth in pill form or by intravenous (IV) infusion.
To treat PCP, TMP-SMX must be taken every day for approximately three weeks. After the infection has cleared, patients will need to take lower doses by mouth either once a day or three-times weekly to prevent it from returning.
Unfortunately, between 25% and 50% of HIV-positive people are allergic to the the sulfur in sulfamethoxazole. Two of the main symptoms seen in people with allergic reactions to SMX are fever and rash. Very often, the allergy can be so severe that people need to stop taking SMX.
For patients who cannot tolerate SMX, the following treatments can be prescribed. While TMP-SMX is clearly the best treatment to choose from, these treatments have been shown to be effective:
Other treatments for PCP:
Pentamidine: To treat PCP, pentamidine is administered through an IV line every day for three weeks. Generally speaking, intravenous pentamidine should be the second choice for the treatment of severe PCP, if TMP-SMX cannot be taken.
Clindamycin-primaquine: This dual-combination of drugs is usually taken by mouth for three weeks. Clindamycin-primaquine has been shown to be effective for the treatment of mild-to-moderate PCP. For severe cases of PCP, clindamycin can be administered through an IV line (primaquine must still be taken by mouth).
Trimethoprim (TMP)-dapsone: Both of these drugs are taken by mouth for three weeks. While it is not as effective for the treatment of severe PCP, TMP-dapsone appears to be just as effective as TMP-SMX, possibly with fewer side effects, for the treatment of mild-to-moderate PCP. However, TMP-dapsone is considered to be less convenient than TMP-SMX, given that a larger number of pills need to be taken every day.
Trimetrexate-leucovorin: Trimetrexate is administered by IV while leucovorin is taken by mouth. After the three-week treatment schedule has finished, leucovorin will need to be taken for an additional three days to help counter the side effects of trimetrexate. This regimen is considered to be less effective than TMP-SMX, but can be used if TMP-SMX cannot be tolerated.
Aerosolized pentamidine (NebuPent®): While this therapy has been used to treat PCP in the past, it is no longer recommended. The above listed drug combinations are believed to be more effective that aerosolized pentamidine. Plus, patients treated with aerosolized pentamidine are more likely to experience a relapse of PCP, compared to those who take the recommended oral or intravenous drug combinations.
Prednisone: By itself, prednisone is not a treatment for PCP. It is a powerful drug that can help control symptoms of PCP, especially for those with severe disease. Patients usually take 40 mg of the drug for five days and then drop the dose to 20 mg a day until PCP therapy is completed.
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