Sulfamethoxazole (SMX)/trimethoprim (TMP) is the treatment of choice for PCP pneumonia. The IV formulation has been unavailable for almost a year due to shortage. It is contraindicated in patients with sulfa allergy. Here are the alternatives with adverse effects. You'll quickly see why pentamidine should generally be reserved for those with sulfa allergy and G6PD deficiency.
Mild-to-moderate disease:
Primaquine 15-30 mg PO PLUS Clindamycin 600 mg IV or 300-450 mg PO
Dapsone 100 mg PO PLUS TMP 5 mg/kg PO
Atovaquone suspension 750 mg PO
Moderate-to-severe disease:
Primaquine 15-30 mg PO PLUS Clindamycin 600 mg IV or 300-450 mg PO
Pentamidine 4 mg/kg IV
Adverse Effects:
Primaquine: Rash, fever, methemoglobinemia, hemolytic anemia (check for G6PD deficiency)
