title: ECIL guidelines for treatment of Pneumocystis jirovecii pneumonia in non-HIV-infected haematology patients.
abstract: The initiation of systemic antimicrobial treatment of Pneumocystis jirovecii pneumonia (PCP) is triggered by clinical signs and symptoms, typical radiological and occasionally laboratory findings in patients at risk of this infection. Diagnostic proof by bronchoalveolar lavage should not delay the start of treatment. Most patients with haematological malignancies present with a severe PCP; therefore, antimicrobial therapy should be started intravenously. High-dose trimethoprim/sulfamethoxazole is the treatment of choice. In patients with documented intolerance to this regimen, the preferred alternative is the combination of primaquine plus clindamycin. Treatment success should be first evaluated after 1 week, and in case of clinical non-response, pulmonary CT scan and bronchoalveolar lavage should be repeated to look for secondary or co-infections. Treatment duration typically is 3 weeks and secondary anti-PCP prophylaxis is indicated in all patients thereafter. In patients with critical respiratory failure, non-invasive ventilation is not significantly superior to intubation and mechanical ventilation. The administration of glucocorticoids must be decided on a case-by-case basis.
authors.affiliation: Department of Haematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Maschmeyer
authors.affiliation: Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jannik
authors.initials: J
authors.lastname: Helweg-Larsen
authors.affiliation: Institute of Haematology, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Livio
authors.initials: L
authors.lastname: Pagano
authors.affiliation: Department of Haematology, Assistance Publique-hôpitaux de Paris (APHP), Henri Mondor Teaching Hospital, Créteil, France University Paris-Est Créteil (UPEC), Créteil, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Robin
authors.affiliation: Department of Haematology, Assistance Publique-hôpitaux de Paris (APHP), Henri Mondor Teaching Hospital, Créteil, France University Paris-Est Créteil (UPEC), Créteil, France catherine.cordonnier@aphp.fr.
authors.forename: Catherine
authors.initials: C
authors.lastname: Cordonnier
authors.affiliation: Department of Medicine I, Intensive Care Unit 13i2, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria Intensive Care in Hematologic and Oncologic Patients (iCHOP).
authors.forename: Peter
authors.initials: P
authors.lastname: Schellongowski
mesh_terms: D061605:Administration, Intravenous; D000935:Antifungal Agents / Q000008:administration & dosage*; D002981:Clindamycin / Q000008:administration & dosage; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D045363:Pneumocystis carinii / Q000187:drug effects*; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy*; D011319:Primaquine / Q000008:administration & dosage; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage
chemical_list: D000935:Antifungal Agents; D002981:Clindamycin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D011319:Primaquine