What is the indication for adjunctive corticosteroid therapy for Pneumocystis jiroveci pneumonia (PJP)?

Updated: Apr 24, 2019
  • Author: Shelley A Gilroy, MD, FIDSA; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Answer

Answer

Corticosteroids are used as adjunctive initial therapy only in patients with HIV infection who have severe P jiroveci pneumonia (PJP) as defined by a room air arterial oxygen pressure of less than 70 mm Hg or an arterial-alveolar O2 gradient that exceeds 35 mm Hg. Adjunctive steroids are not recommended in patients without HIV infection.

Microbial degradation and clearance may trigger further inflammation, which can provoke a severe inflammatory response in the lungs that often worsens after therapy is begun. Adjunctive corticosteroid therapy can blunt this inflammatory response, reduce deterioration of oxygenation, and reduce the incidence of respiratory failure. [39, 40]


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