Treatment of Pneumocystis jirovecii Pneumonia with Caspofungin and Clindamycin: An HIV Patient and Literature Review

The first-line treatment for Pneumocystis jirovecii pneumonia (PCP) is trimethoprim-sulfamethoxazole (TMP-SMZ). However, some cases require alternative agents due to the side effects of TMP-SMZ. Treatment with TMP-SMZ was initiated in an HIV-positive patient with microbiologically confirmed PCP, who presented with acute renal failure on admission. On the third day of treatment, TMP-SMZ was discontinued due to worsening renal function. Subsequently, clindamycin was initiated in combination with caspofungin. Although caspofungin-based therapies were shown to be effective against Pneumocystis in animal models, clinical experience in humans is limited. The patient was treated successfully with clindamycin combined with caspofungin.