Prophylaxis for Pneumocystis jiroveci pneumonia: is it a necessity in pulmonary patients on high-dose, chronic corticosteroid therapy without AIDS?

Expert Review of Respiratory Medicine
Maryjane LieblingSusanti Ie

Abstract

The benefit of prophylaxis for Pneumocystis jirovecii pneumonia (PJP) is well documented in immunocompromised patients, particularly those with HIV and/or AIDS; therefore, guidelines dictate this as standard of care. However, there is a paucity of literature regarding those without HIV and/or AIDS who are potentially predisposed to PJP, including patients with sarcoidosis, cryptogenic organizing pneumonia, interstitial lung disease, asthma and chronic obstructive pulmonary disease, who may require high dose of prolonged corticosteroids for disease maintenance or to prevent relapses. In this review, the authors examine the available literature regarding prophylaxis in these groups, elaborate on the pathogenesis of PJP, when to suspect PJP in these patients, as well as explore current recommendations that guide clinical practice regarding implementation of PJP prophylaxis, namely with trimethoprim/sulfamethoxazole being the preferred agent. In summary, the role of PJP prophylaxis in non-HIV patients on chronic steroids remains controversial. The authors present a review of the literature to provide better guidance to the clinician regarding the need to initiate PJP prophylaxis in this patient population.

References

Apr 1, 1978·Environmental Health Perspectives·P D MoorheadF L Schanbacher
Dec 29, 1977·The New England Journal of Medicine·W T HughesS L George
Feb 12, 1992·JAMA : the Journal of the American Medical Association·K A SepkowitzD Armstrong
Jan 1, 1992·Southern Medical Journal·R W Farr
Dec 1, 1990·The Journal of Infectious Diseases·S A Bozzette
Jun 1, 1986·Transplantation·J S DummerM Ho
Jun 25, 1987·The New England Journal of Medicine·W T HughesL Lott
Feb 1, 1987·Annals of Internal Medicine·J M HofflinJ S Remington
Mar 1, 1973·The Journal of Pediatrics·W T HughesS Feldman
Nov 1, 1982·Reviews of Infectious Diseases·J D MeyersE D Thomas
Sep 1, 1984·Annals of Internal Medicine·B S Graham, W S Tucker
Apr 1, 1980·American Journal of Diseases of Children·S R SiegelM H Kanter
Nov 28, 1980·JAMA : the Journal of the American Medical Association·E J WingS Adler
Aug 1, 1993·British Heart Journal·D P DutkaG K Morris
Nov 1, 1993·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·K A Sepkowitz
Feb 1, 1993·The American Journal of Medicine·A SlivkaJ S Loeffler
Feb 1, 1997·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·T M JivaA C Portmore
Oct 29, 1998·FEMS Immunology and Medical Microbiology·M C PrévostE Dei-Cas
Nov 17, 1998·American Journal of Respiratory and Critical Care Medicine·B E LamsT H Lee
Mar 5, 1999·The European Respiratory Journal·E MonsóJ Morera
Mar 5, 1999·The European Respiratory Journal·R ZalacainJ L Llorente
Oct 19, 1999·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·G NevezE Dei-Cas
Mar 22, 2000·The Journal of Immunology : Official Journal of the American Association of Immunologists·R VassalloA H Limper
Mar 27, 2002·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Kent A Sepkowitz
Aug 27, 2002·Emerging Infectious Diseases·James R StringerAnn E Wakefield

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Citations

Jan 21, 2021·JAAPA : Official Journal of the American Academy of Physician Assistants·Matthew DameronNathalie Abi Hatem
Jan 8, 2021·BMC Pulmonary Medicine·Marisol Arroyo-HernándezOscar Arrieta
May 22, 2021·Chest·Vidushi SoodSandhya Khurana
Oct 27, 2021·Medical Mycology·Lidia GoterrisMaría Teresa Martin-Gomez

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