Guideline sources The following summarized guidelines for the evaluation and management of pneumocystis pneumonia in HIV-negative hematology patients (PCP in HIV-negative hematology patients) are prepared by our editorial team based on guidelines from the European Conference on Infections in Leukaemia (ECIL 2016). 1 Calculator Miller criteria for PCP severity as Guidelines 1. Classification and risk stratification Severity assessment: classify non-HIV infected patients with Pneumocystis pneumonia as having mild versus moderate-to-severe disease severity. B Show 3 more 2. Medical management https://web.pathway.md/diseases/rec7pgu2qBbRcgvWH 1/3 6/29/23, 11:16 PM Pneumocystis pneumonia in HIV-negative hematology patients Pathway Indications for treatment: Use composite criteria to assess the need for diagnostic bronchoscopy and empiric treatment against P. jirovecii, as single clinical diagnostic criteria are insufficient to prove the diagnosis. Factors that increase clinical suspicion include: patient at risk clinical signs and symptoms: dyspnea and/or cough, fever (may rarely be absent), hypoxemia (may not yet be present), chest pain (rare; usually from pneumothorax) radiology findings compatible with Pneumocystis pneumonia (preferably thoracic CT scan) with or without unexplained serum LDH elevation. B Route of administration: consider oral antimicrobial treatment in patients with mild Pneumocystis pneumonia in whom enteral absorption is not compromised and good adherence to treatment is expected. C Show 2 more Duration of treatment: complete a 3 week duration of antimicrobial treatment in patients with Pneumocystis pneumonia. B First-line therapy: administer TMP/sulfamethoxazole (15-20 mg/kg TMP and 75-100 mg/kg sulfamethoxazole, divided in 3-4 doses daily for 14 days) as first-line treatment for Pneumocystis pneumonia. B Second-line therapy: Administer primaquine plus clindamycin as the preferred second-line therapy in non-HIV patients with Pneumocystis pneumonia. B Consider the following alternatives to primaquine plus clindamycin: intravenous pentamidine 4 mg/kg/day C high-dose TMP/sulfamethoxazole, plus caspofungin 50-70 mg per day C Adjunctive corticosteroids: avoid the routine adjunctive use of adjunctive corticosteroids in non-HIV patients with Pneumocystis pneumonia and respiratory failure. Decide on the initiation of adjunctive corticosteroids on an individual basis. D 3. Specific circumstances Patients with respiratory failure: monitor patients with Pneumocystis pneumonia for acute respiratory failure requiring ICU admission, since late ICU transfers are associated with increased mortality rates. B Show 2 more 4. Preventative measures Secondary prophylaxis: administer secondary anti-Pneumocystis pneumonia prophylaxis in all non-HIV patients who have been successfully treated for Pneumocystis pneumonia. B 5. Follow-up and surveillance https://web.pathway.md/diseases/rec7pgu2qBbRcgvWH 2/3 6/29/23, 11:16 PM Pneumocystis pneumonia in HIV-negative hematology patients Pathway Assessment of treatment response: assess the efficacy of systemic antimicrobial treatment on a daily basis. While early clinical deterioration (within the first 3-5 days after treatment initiation) is common, avoid diagnostic reevaluation before 8 days of full-dose treatment. B Show 3 more Clinical findings Symptoms Past medical history Chest pain Cancer Chills Respiratory exam Dry cough Fatigue Wheezing Fever Shortness of breath Vital signs Weight loss References 1. Maschmeyer G, Helweg-Larsen J, Pagano L et al. ECIL guidelines for treatment of Pneumocystis jirovecii pneumonia in non-HIV-infected haematology patients. J Antimicrob Chemother. 2016 Sep;71 9 2405 13. Open 2. R F Miller, J Le Noury, E L Corbett et al. Pneumocystis carinii infection: current treatment and prevention. J Antimicrob Chemother. 1996 May;37 Suppl B 33 53. Open https://web.pathway.md/diseases/rec7pgu2qBbRcgvWH 3/3