Use of echinocandins combined with clindamycin in Pneumocystis pneumonia: a case series of 14 patients

J Antimicrob Chemother. 2025 Jan 3;80(1):102-105. doi: 10.1093/jac/dkae379.

Abstract

Background: Pneumocystis jirovecii pneumonia (PcP) is an opportunistic infection for which the standard of care is co-trimoxazole. However, safety concerns and intolerance may compromise its utility.

Objectives: To evaluate the safety and efficacy of the combination of echinocandins and clindamycin to treat PcP.

Patients and methods: We investigated 14 patients treated with a co-trimoxazole-free combined regimen that included echinocandins and clindamycin.

Results: Clinical cure was achieved in 8 out of 14 patients, while 5 had a fatal outcome due to their primary disease; however, only one patient died due to PcP.

Conclusions: Echinocandin and clindamycin may be a safe and effective alternative treatment for patients who cannot be given co-trimoxazole for PcP.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / therapeutic use
  • Antifungal Agents* / administration & dosage
  • Antifungal Agents* / adverse effects
  • Antifungal Agents* / therapeutic use
  • Clindamycin* / administration & dosage
  • Clindamycin* / therapeutic use
  • Drug Therapy, Combination
  • Echinocandins* / administration & dosage
  • Echinocandins* / adverse effects
  • Echinocandins* / therapeutic use
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pneumocystis carinii / drug effects
  • Pneumonia, Pneumocystis* / drug therapy
  • Treatment Outcome

Substances

  • Clindamycin
  • Antifungal Agents
  • Echinocandins
  • Anti-Bacterial Agents