PJP prophylaxis (formerly PCP)
Prophylaxis of Pneumocystis jiroveci (carinii) pneumonia in adults
Pneumocystis jiroveci (carinii) (PJP) is a fungus that causes infection specific to humans. The great majority of infections occur in immunocompromised patients and are associated with respiratory symptoms. Link to guidelines for treatment of PJP.
Prophylaxis is indicated in the following patient groups with variation in the drugs used:
HIV seropositive individuals
Start primary prophylaxis when CD4 count less than 200cells/μL or CD4% less than 14 or CD4 count between 200 and 250cells/μL if initiation of antiretroviral therapy is delayed and if regular CD4 count monitoring is not possible.
Start secondary prophylaxis after completing PJP treatment
After starting antiretroviral therapy PJP prophylaxis is usually continued until CD4 count is greater than 200cells/μL for at least 3 months or until CD4 counts between 100 and 200 cells/mm3 if the plasma HIV load remains undetectable for 3–6 months.
Those with previously confirmed PJP infection may need longer prophylaxis.
Preferred
co-trimoxazole 480mg po od
dapsone 100mg po od
Contraindicated in G6PD deficiency. Check G6PD activity before starting treatment.
atovaquone 750mg po bd
Has to be taken with food to improve absorption. High cost.
Kidney, pancreas, simultaneous pancreas and kidney (SPK) and intestinal transplant:
Start PJP prophylaxis on day 1 after transplant and continue for 12 months. Access individual protocols on the Intranet
Preferred
co-trimoxazole 480mg po od
Alternatives
dapsone 100mg po od
Contraindicated in G6PD deficiency. Check G6PD activity before starting treatment
pentamidine intravenously or nebulised monthly
Practice varies across centres. Only nebulised route is licensed for prophylaxis. Special precautions are required for nebulisation. Intravenous administration for prophylaxis is unlicensed. For dosing advice contact transplant pharmacist on bleep 5111.
Haematology/Oncology patients:
The indication for PJP prophylaxis will vary according to the condition and chemotherapy used.
All cases should be discussed with Haematology/Oncology teams:
Myeloid (AML, allografts, AA, and Crohn’s) team SpR bleep 1700
Lymphoma (TTP, sickle cell) team SpR 1902
On call SHO after 5pm and at weekends bleep 5160
References
Dockrell DH et al. British HIV Association guidelines on the management of opportunistic infection in people living with HIV: the clinical management of pulmonary opportunistic infections 2024. HIV Med. 2024;25(Suppl 2):3–37. Available from: BHIVA guidelines on the management of opportunistic infection in people living with HIV: The clinical management of pulmonary opportunistic infections 2024 – BHIVA . Accessed: 08/07/2025
Mason P. et al, (2022). Oxford University Hospitals NHS Foundation Trust. Renal Transplant Clinic Guideline. Version 9.0. Accessed: 08/07/2025
Sharples E. et al, (2022). Oxford University Hospitals NHS Foundation Trust. Pancreas Transplant: In-Patient Management Guideline Module. Version 4.0. Accessed: 08/07/2025
Johnson, P., et al. (2018). Oxford University Hospitals NHS Foundation Trust Islet Transplant: Islet Transplant Alone (ITA) and Simultaneous Islet Kidney (SIK) Transplant In-patient Management Guideline. Version 1.0. Accessed:08/07/2025
Reddy S. et al, (2021). Oxford University Hospitals NHS Foundation Trust. Intestinal Transplant: In-patient Management Guideline Module. Version 1.1.
Peniket, A. (2024). Oxford University Hospitals NHS Foundation Trust Guideline. Prophylaxis and Treatment of Pneumocystis Jirovecii Pneumonia (PJP) for Allogeneic and Autologous Blood and Marrow Transplant (BMT) Recipients. Version 5.2. Accessed: 08/07/2025
Summary of Product Characteristics for Pentacarinat 300mg Powder for Solution for Injection/Infusion. Sanofi, UK. Last updated 15/08/2019. Available via https://www.medicines.org.uk/emc/product/977/smpc. Accessed: 08/07/2025