Positioning Second-line Therapies for Pneumocystis Jirovecii Pneumonia (PCP Alternatives)

Exclusion criteria

• ✕. Previous severe adverse reaction or hypersensitivity to clindamycin, primaquine, or atovaquone (mild-moderate PCP) or to clindamycin, primaquine, or pentamidine (severe PCP);
• ✕. More than 7 calendar days of any therapy for PCP (no more than 4 can involve a study drug).
• ✕. Known pregnancy or breastfeeding (pregnancy test will be offered)
• ✕. For clindamycin-primaquine:
• ✕. Known G6PD deficiency OR family history of G6PD deficiency without excluding by testing\*
• ✕. Known diagnosis of porphyria
• ✕. Concomitant use of methotrexate or cyclophosphamide which cannot be held \*G6PD deficiency is an X-linked recessive genetic disease. Female patients without a family history are very unlikely to have this disease and so therapy can start while waiting for the test in the absence of a family history. Male patients should wait for test results prior to receiving primaquine even if they do not have a family history. For those without G6PD testing at diagnosis, it is a reasonable standard of care to order testing.
• ✕. For pentamidine: