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PNEUMOCYSTIS jerovicii PROPHYLAXIS
(Note: New name for PCP)


First Line
Co-trimoxazole 480mg od

If documented allergy to co-trimoxazole consider desensitisation regimen as soon as patient able to tolerate oral medicines post-transplant:

Day
 Preparation
 Dose
1

Co-trimoxazole suspension   2.4mg/mla

 1ml
2   2ml
3   4ml
4   8ml
5   12ml
6

Co-trimoxazole suspension   2mg/mlb

 1.25ml
7   2.5ml
8   5ml
9   10ml
10

Co-trimoxazole 480mg tablet

 ONE


a    Co-trimoxazole paediatric suspension 240mg/5ml diluted 1:20
b    Co-trimoxazole paediatric suspension 240mg/5ml undiluted

Second Line
Dapsone 100mg od

Consider dose reduction to 50mg od in severe renal dysfunction (creatinine clearance <10ml/min)


Third Line
Nebulised pentamidine 300mg every 4 weeks – refer to following guidelines for details of administration.
 

Administration of Nebulised Pentamidine

Equipment
Pentamidine nebuliser solution 300mg x 1
Salbutamol 2.5mg/2.5ml nebule x 1
NaCl 0.9% 5ml x 1
Nebuliser compressor
ISO-NEB Filtered Nebuliser System (Ref 41755) and elephant tubing for pentamidine
Nebulising chamber and mask for salbutamol
Apron
Pair of Safeskin-Purple Nitrile gloves
P1 type mask
Pair of goggles
“Do not enter” sign

Method

  1. Put patient in dedicated room with window to outside and closed door.  Place “Do not enter” sign on outside of door informing others not to enter.
  2. Administer salbutamol nebule as per usual practice.
  3. Put on apron, gloves, mask and goggles.
  4. Prepare nebulising equipment for administration of pentamidine.
  5. Connect ISO-NEB Filtered Nebuliser System to compressor.
  6. Place elephant tubing out of open window.
  7. Draw up pentamidine nebuliser solution and add to chamber of ISO-NEB Filtered Nebuliser System.
  8. Instruct patient to form a tight seal around mouthpiece during administration and to switch compressor off during treatment if mouthpiece needs to be removed from mouth.
  9. Leave the room.
  10. Indicate to patient to start compressor.
  11. If patient is unable to start compressor by his/herself then start it for him/her and leave the room immediately.
  12. Check patient every 5 minutes for 20 minutes until nebulisation complete.  If there is any need to need to enter the room during administration put on apron, gloves, mask and goggles before entering and switch off the compressor immediately after entering.
  13. Indicate to patient to switch off compressor and leave room, closing door behind.
  14. DO NOT enter room for at least 2 hours after completion of nebulised pentamidine.
  15. Enter room and dispose of nebulising equipment in orange clinical waste bag inside room.


Reference Source
Electronic Medicines Compendium http://emc.medicines.org.uk/
 

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