Pneumocystis pneumonia prophylaxis

Antimicrobial prophylaxis for Pneumocystis jirovecii in patients with severe immunosuppression (HIV with CD4 below 200 cells/uL, post-HSCT, solid organ transplant recipients, prolonged high-dose glucocorticoid therapy).

ICD-10 B591 drug

Also known as: PJP prophylaxis, PCP prophylaxis

Drugs used for this condition

ACo-trimoxazoleFirst line · Sulfonamide-trimethoprim combinationCo-trimoxazole is the first-line agent for Pneumocystis jirovecii prophylaxis in HIV patients with CD4 below 200 cells/uL, after HSCT, in solid organ transplant recipients, and in patients on prolonged high-dose glucocorticoids. CDC/NIH/IDSA 2024 recommend co-trimoxazole 80/400 mg daily or 160/800 mg three times weekly. The 2014 Cochrane review confirms an 85% reduction in PJP incidence in non-HIV immunocompromised patients.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit