Department of Haematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany.
Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
J Antimicrob Chemother. 2016 Sep;71(9):2405-13. doi: 10.1093/jac/dkw158. Epub 2016 May 12.
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.
肺孢子菌肺炎（PCP）的全身抗微生物治疗的启动是由有感染风险的患者的临床症状和体征、典型的影像学和偶尔的实验室发现触发的。支气管肺泡灌洗的诊断证据不应延迟治疗的开始。大多数血液系统恶性肿瘤患者表现为严重的 PCP；因此，应静脉内给予抗菌治疗。大剂量甲氧苄啶/磺胺甲噁唑是首选治疗方法。对于有该方案不耐受记录的患者，首选替代方案是青蒿素加克林霉素联合治疗。应在治疗后 1 周首次评估治疗效果，如果临床反应不佳，应重复肺部 CT 扫描和支气管肺泡灌洗，以寻找继发性或合并感染。治疗时间通常为 3 周，此后所有患者均需要进行继发性抗 PCP 预防。在有严重呼吸衰竭的患者中，无创通气并不明显优于插管和机械通气。糖皮质激素的使用必须根据具体情况决定。
