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No definitive studies have been performed to determine the optimal management of AIDS patients who do not respond to first-line treatment for Pneumocystis jirovecii pneumonia (PCP). To address this gap, investigators conducted a systematic review of 29 studies that described second-line treatment for a total of 468 episodes of PCP. All but one of the studies were published between 1982 and mid-2007; the other was an unpublished case series from Europe that involved 82 HIV-infected patients who required second-line therapy for PCP between 1989 and 2004. Across the studies, all patients were HIV infected, had microbiologically proven PCP, and remained on their initial PCP regimens for at least 5 days before switching because of inadequate res…