There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral suspension
Tablet
CAUTIONARY AND ADVISORY LABELS 9, 21
▶Griseofulvin (Non-proprietary)
Griseofulvin 125 mg Griseofulvin 125mg tablets | 100 tablet P
£96.67 DT = £96.67
Griseofulvin 500 mg Griseofulvin 500mg tablets | 90 tablet P
£81.32 | 100 tablet P £90.34 DT = £90.35
3.1 Pneumocystis pneumonia
Pneumocystis pneumonia
Overview
Pneumonia caused by Pneumocystis jirovecii (Pneumocystis
carinii) occurs in immunosuppressed patients; it is a
common cause of pneumonia in AIDS. Pneumocystis
pneumonia should generally be treated by those experienced
in its management. Blood gas measurement is used to assess
disease severity.
Treatment
Mild to moderate disease
Co-trimoxazole p. 594 in high dosage is the drug of choice
for the treatment of mild to moderate pneumocystis
pneumonia.
Atovaquone below is licensed for the treatment of mild to
moderate pneumocystis infection in patients who cannot
tolerate co-trimoxazole. A combination of dapsone p. 610
with trimethoprim p. 607 is given by mouth for the
treatment of mild to moderate disease [unlicensed
indication].
A combination of clindamycin p. 564 and primaquine
p. 654 by mouth is used in the treatment of mild to moderate
disease [unlicensed indication]; this combination is
associated with considerable toxicity.
Severe disease
Co-trimoxazole in high dosage, given by mouth or by
intravenous infusion, is the drug of choice for the treatment
of severe pneumocystis pneumonia. Pentamidine isetionate
below given by intravenous infusion is an alternative for
patients who cannot tolerate co-trimoxazole, or who have
not responded to it. Pentamidine isetionate is a potentially
toxic drug that can cause severe hypotension during or
immediately after infusion.
Corticosteroid treatment can be lifesaving in those with
severe pneumocystis pneumonia.
Adjunctive therapy
In moderate to severe infections associated with HIV
infection, prednisolone p. 716 is given by mouth for 5 days
(alternatively, hydrocortisone p. 713 may be given
parenterally); the dose is then reduced to complete 21 days
of treatment. Corticosteroid treatment should ideally be
started at the same time as the anti-pneumocystis therapy
and certainly no later than 24–72 hours afterwards. The
corticosteroid should be withdrawn before anti-
pneumocystis treatment is complete.
Prophylaxis
Prophylaxis against pneumocystis pneumonia should be
given to all patients with a history of the infection.
Prophylaxis against pneumocystis pneumonia should also be
considered for severely immunocompromised patients.
Prophylaxis should continue until immunity recovers
sufficiently. It should not be discontinued if the patient has
oral candidiasis, continues to lose weight, or is receiving
cytotoxic therapy or long-term immunosuppressant therapy.
Co-trimoxazole by mouth is the drug of choice for
prophylaxis against pneumocystis pneumonia. It is given
daily or on alternate days (3 times a week); the dose may be
reduced to improve tolerance.
Inhaled pentamidine isetionate is better tolerated than
parenteral pentamidine isetionate. Intermittent inhalation
of pentamidine isetionate is used for prophylaxis against
pneumocystis pneumonia in patients unable to tolerate co-
Infection
trimoxazole. It is effective but patients may be prone to
extrapulmonary infection. Alternatively, dapsone can be
used. Atovaquone has also been used for prophylaxis
[unlicensed indication].
ANTIPROTOZOALS › OTHER
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