Opportunistic Infections Flashcards
PCP (Pneumocystis pneumonia):
Primary Prophylaxis (1st line)
DS TMP/SMX PO QD (160/800)
or
SS TMP/SMX PO QD (80/400)
PCP (Pneumocystis pneumonia):
Secondary Prophylaxis (5 options)
- DS Bactrim TIW
- Dapsone 50mg PO QD + pyrimethamine 50mg PO QW + leukovorin 25mg PO QW
- Aerosolized pentamidine
- Atovaquone
G6PDH Allergy –> atovaquone
PCP (Pneumocystis pneumonia):
INDICATION for Primary Prophylaxis
CD4+ Count < 200cells/mm3
or
Presence of oral candidiasis
PCP (Pneumocystis pneumonia):
DISCONTINUATION of Primary Prophylaxis
CD4 + Count ≥ 200 cells/mm3 for > 3 months (while on ART)
Oral Candidiasis (Thrush):
Primary Prophylaxis
None
Toxoplasma gondii:
Primary Prophylaxis
DS TMP/SMX PO QD (160/800)
Toxoplasma gondii:
Secondary Prophylaxis (3 options)
- Bactrim DS PO TIW
- Dapsone 50mg PO QD + pyrimethamine 50mg PO QW + leucovorin 25mg PO QW
- Atovaquone +/- pyrimethamine + leucovorin
leucovorin added b/c myelosuppression from pyrimethamine
Toxoplasma gondii:
INDICATION for Primary Prophylaxis
Toxoplasma + IgG
+
CD4+ count < 100cells/mm3
Toxoplasma gondii:
DISCONTINUATION for Primary Prophylaxis
CD4+ count > 200cells/mm3 for > 3 months
Mycobacterium avium complex (MAC):
Primary Prophylaxis
Azithroymcin 1200mg PO QW
Mycobacterium avium complex (MAC):
Secondary Prophylaxis (3 options)
- Clarithromycin 500mg PO BID
- Azithromycin 600mg PO BIW
- Rifabutin (dose adjust based on ART)
- *RED + rule out TB before use**
Mycobacterium avium complex (MAC):
INDICATION for Primary Prophylaxis
CD4+ Count < 50cells/mm3
active dissemination needs to be ruled out
Mycobacterium avium complex (MAC):
DISCONTINUATION for Primary Prophylaxis
CD4+ count > 100cells/mm3 for ≥ 3 months
Candidiasis (oropharyngeal + esophagela) Treatment
CD4+ @ < 200cells/mm3
1.) Fluconzole
2.) Itraconazole, Posaconazole
Secondary: None
Cytomegalovirus (CMV) Treatment
- retinitis
- encephalopathy
- gastroenteritis
CD4+ < 100cells/mm3
1.) Valganciclovir, Ganciclovir
or
(resistance) Foscarnet, cidofovir
2.) Valganciclovir
Cryptococcal meningitis Treatment
1.) AmpB deoxycholate + flucytosine or AmpB (liposome) + flucytosine or Fluconazole + flucytosine
2.) Fluconazole (low dose)
Renal Issues: Deoxy»_space; Liposome
MAC Infection Treatment
1.) Azithromycin or Clarithromycin + Ethambutol
or
Add 3rd or 4th Line:
[Rifabutin, amikacin, streptomycin, moxifloxacin, levofloxacin]
2.) same as alternatives for 1st line
Pneumocystis pneumonia (PCP) Treatment
1.) SMX/TMP +/- Corticosteroid (21d) or Atovaquone or (clindamycin + primaquine) or pentamidine IV or (dapsone + trimethoprim)
2.) SMX/TMP or dapsone or (dapsone + dyrimethamine) or atovaquone or inhaled pentamidine
Toxoplasmosis meningoencephalitis Treatment
1.) Pyrimethamine + sulfadiazine or SMX/TMP or Pyrimethamine + (clindamycin + azithromycin) or atovaquone or sulfadiazine +/- pyrimethamine
Pyrimethamine Myelosuppression Tx
LEUCOVORIN 25mg PO QW
