Treatment of anti-pneumocystis (Pneumocystis carinii) is recommended

Pneumocystis pneumonia (PCP) is caused by pneumocystis infection of the lungs, and is most common in immunodeficient populations (including AIDS, tumor radiotherapy and chemotherapy, the use of immunosuppressants such as prednisone, organ transplantation, autoimmune diseases, diabetes mellitus, chronic liver disease, chronic kidney disease, intensive care ward patients, etc.), fever and dyspnea symptoms can occur, and the mortality rate is extremely high if not treated in time. In addition to anti-inflammatory, symptomatic, supportive, nutritional, immune-boosting, anti-pneumocystis therapy is the key to the treatment of the disease.

First-line anti-pneumocystis treatment plan

The preferred anti-pneumocystis drug is a compound preparation: trimethoprim / sulfamethiazole (tmp / smx), the dosage form is 80mg / 400mg; because there is no domestic drug, so more choice of trimethoprim / sulfamethoxazole (tmp / smz), that is, often said compound new nordazole, dosage form is the same as tmp / smx. Dosage: tmp 15–20 mg/kg bw/day and smx 75–100 mg/kg bw/day. Course of medication: generally 3 weeks. During the trial period, hydrate more, reduce the crystallization of drugs in the renal tubules, and pay attention to the observation of drug side reactions: allergic rash, drug fever, liver dysfunction, cytopenia, nausea and vomiting.

Second- and second-line anti-pneumocystis treatment regimens

As mentioned above, the use of the above-mentioned sulfonamide first-line antipsychomycosis may present with a series of side effects that cause the patient to be unable to tolerate the continuation of the affected treatment. In addition, most of the treatment of sulfa anti-pneumocystis was effective in one week, and the symptoms improved significantly in two weeks. If the standardized treatment is one week, the effect is not obvious, there may be pneumocystis resistance to sulfonamides (unfortunately, the current clinical practice can not carry out pneumoconiosis culture and drug resistance identification), it is recommended to change the treatment plan in time. Anti-pneumocystis substitution regimens are clindamycin plus primaquine or intravenous pentamidine. Unfortunately, at present, domestic pentamidine is difficult to obtain, primaquine is an antimalarial drug, and it is difficult for general hospitals and pharmacies to purchase drugs. Most doctors use clindamycin plus caspofenin, which is effective in some patients, but there is a gap in efficacy compared with clindamycin plus primaquine or intravenous spentamine.

3. Sequential treatment

At the end of the 21-day standard anti-pneumocystis treatment course, the lung lesions were not fully absorbed, and whether the course of treatment needed to be extended was controversial. Most of the foreign research data support not prolonging the course of treatment. In addition, at the end of treatment, it is recommended to maintain therapy with 2 tablets of tmp/smz per day to prevent recurrence. For AIDS patients, it is necessary to eat at least half a year, and completely stop the drug after 3-6 months after CD4 is greater than 200 /ml. For other immunodeficient populations, there are no study data on standard sequential treatment courses, and sequential treatment courses can be determined based on the type, extent, and duration of immunodeficiency. It is generally recommended to maintain 2 tablets of tmp/smz for 6-12 months.