Question | Discussion | References | CME Credit

Case 1: Prophylaxis for Pneumocystis Pneumonia

You answered:

A This patient should receive Pneumocystis pneumonia prophylaxis, but prior to initiating prophylaxis, a sputum sample should be sent to perform Pneumocystis jiroveci resistance testing.

This answer is incorrect. This HIV-infected patient should receive Pneumocystis prophylaxis based on his oral candidiasis and AIDS-defining illness (two or more episodes of bacterial pneumonia in a 1-year period is an AIDS-defining illness). This answer is not correct because Pneumocystis jiroveci resistance testing is not commercially available and not recommended.

Choose another answer:

B The patient does not need Pneumocystis pneumonia prophylaxis; he should start prophylaxis if his CD4 count decreases to less than 200 cells/mm3.
C The patient should start on Pneumocystis pneumonia prophylaxis using trimethoprim-sulfamethoxazole at a dose of one double strength tablet per day.
D The patient should receive Pneumocystis pneumonia prophylaxis, but first should undergo bronchoscopy to rule out active Pneumocystis pneumonia prior to receiving prophylaxis.

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