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

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.