ID IV: Opportunistic Infections Flashcards
Criteria for starting PCP prophy
CD4 <200 or AIDS-defining illness
Primary PCP prophy choice
Bactrim QD
Alternative PCP prophy options
Dapsone +/- pyrimethamine/leucovorin
Atovaquone +/- pyrimethamine/leucovorin
Criteria for D/C’ing PCP prophy
CD4 count >200 cells for >3 months on ART
Can consider if CD4 count is 100-200 and viral load has been undectable for ≥3-6 months
Criteria for starting Toxoplasma gondii encephalitis prophy
CD4 <100, toxoplasma IgG positive
Primary Toxoplasma prophy option
Bactrim DS QD
Alternative Toxoplasma prophy options
Dapsone/pyrimethamine/leucovorin
Atovaquone +/- pyrimethamine/leucovorin
Criteria for D/C’ing Toxoplasma prophy
Same as PCP prophy D/C criteria
Can consider if the CD4 count is 100-200 and viral load has been undetectable for ≥3-6 months
Criteria for starting MAC prophy
CD4 <50 and isn’t on ART
Preferred MAC prophy
Azithromycin 1200mg QW
Alternative MAC prophy options
Azithromycin 600mg BIW
Clarithromycin 500mg BID
When to D/C MAC prophy
Starting ART
Preferred treatment for candidiasis
Fluconazole
Alternative treatment for candidiasis: oropharyngeal
itraconazole, posaconazole
Alternative treatment for candidiasis: esophageal
voriconazole, Cresemba, enchinocandin
Secondary prophy treatment for candidiasis
Not recommended
Cryptococcal meningitis preferred treatment
Amphotericin B with flucytosine
Alternate cryptococcal meningitis treatment
Fluconazole with flucytosine
Amphotericin B with fluconazole
Cryptococcal meningitis secondary prophy treatment
Low-dose fluconazole
CMV preferred treatment options
Valganiciclovir, ganiciclovir
Alternate CMV treatment options
foscarnet, cidofovir
CMV secondary prophy treatment
None; just keep the CD4 count >100
MAC preferred treatment options
Clarithromycin or azithromycin + ethambutol
MAC alternate treatment options
Add on a third or fourth agent with rifabuzin, amikacin, streptomycin, moxifloxacin, levofloxacin
MAC secondary prophy treatment
Same as treatment option
PCP preferred treatment
High dose Bactrim
PCP alternate treatment options
Atovaquone
Pentamidine IV
PCP secondary prophy treatment
Same as primary prophy Tx
Toxoplasma preferred treatment
Pyrimethamine + leucovorin + sulfadiazine
Toxoplasma alternate treatment
Bactrim
Toxoplasma secondary prophy treatment
Same as treatment, just smaller doses
Risks for toxoplasma
undercooked/raw meat, cat feces/litter
