title: Prophylaxis for Pneumocystis jiroveci pneumonia: is it a necessity in pulmonary patients on high-dose, chronic corticosteroid therapy without AIDS?
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.
authors.affiliation: Department of Pulmonary, Critical Care, and Sleep Medicine, Carilion Clinic, P.O. Box 13367, Roanoke, VA 24033, USA.
authors.forename: Maryjane
authors.initials: M
authors.lastname: Liebling
authors.forename: Edmundo
authors.initials: E
authors.lastname: Rubio
authors.forename: Susanti
authors.initials: S
authors.lastname: Ie
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods* / Q000592:standards; D004334:Drug Administration Schedule; D006801:Humans; D016867:Immunocompromised Host; D009894:Opportunistic Infections / Q000139:chemically induced / Q000276:immunology / Q000382:microbiology / Q000517:prevention & control*; D045363:Pneumocystis carinii / Q000276:immunology / Q000472:pathogenicity*; D011020:Pneumonia, Pneumocystis / Q000139:chemically induced / Q000276:immunology / Q000382:microbiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage*
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
keywords: Pneumocystis jirovecii pneumonia; asthma; chronic obstructive pulmonary disease; corticosteroids; cryptogenic organizing pneumonia; immunosuppression; interstitial lung disease; prophylaxis; sarcoidosis; trimethoprim/sulfamethoxazole