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Nephrol Dial Transplant (2002) 17: 36-39
© 2002 European Renal Association-European Dialysis and Transplant Association

IV.7.1 Pneumocystis carinii pneumonia

Guidelines

A. Approximately 5% of patients develop Pneumocystis carinii pneumonia (PCP) after renal transplantation if they do not receive prophylaxis. PCP is a severe disease, with a very high fatality rate. Therefore, all renal transplant recipients should receive PCP prophylaxis. The treatment of choice is trimethoprim–sulfamethoxazole (TMP–SMX), at a dose of 80/400 mg/day or 160/800 mg every other day, for at least 4 months. Patients who are treated for rejection should receive TMP–SMX prophylaxis for 3–4 months.

(Evidence level A)

B. In the case of TMP–SMX intolerance, aerosolized pentamidine (300 mg once or twice per month) is an alternative for prophylaxis.

(Evidence level A)

C. The first-line treatment of PCP is high-dose TMP–SMX. Patients with a PaO2 of <70 mmHg initially should be treated parenterally, and the administration of additional steroids should be considered.

(Evidence level A)


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