التهاب الرئة بالمتكيسة الرئوية من درجة متوسطة إلى شديدة غير مستجيب للعلاج الوريدي الأولي

References

1. The severity of PCP can be classified as mild-to-moderate if ≤4.7 kPa or moderate-to-severe if >4.7 kPa (Table 1).
2. Patients with moderate-to-severe PCP (i.e. PaO₂ <9.3 kPa at rest breathing room air) should receive intravenous therapy in hospital and can later be switched to oral therapy to complete treatment.
3. For moderate-to-severe PCP, based on a retrospective study and a systematic review, the combination of clindamycin and primaquine is the preferred alternative regimen to trimethoprim-sulfamethoxazole.
4. Treatment may also be initiated with intravenous clindamycin in those with moderate-to-severe PCP, and then administered orally following clinical recovery.
5. Intravenous pentamidine is almost as effective as trimethoprim-sulfamethoxazole for the treatment of PCP but is less often used due to significant toxicity.
6. Having excluded other causes, any patient not responding between 4 and 8 days should be switched to alternative therapy as shown in Table 2.