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Case 1: Prophylaxis for Pneumocystis Pneumonia

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C The patient should started on Pneumocystis pneumonia prophylaxis using trimethoprim-sulfamethoxazole at a dose of one double strength tablet per day.

This answer is correct. This patient has two indications to receive Pneumocystis pneumonia prophylaxis: (1) oral candidiasis, and (2) an AIDS-defining illness (two or more episodes of bacterial pneumonia in a 1-year period is an AIDS-defining illness). Trimethoprim-sulfamethoxazole is the preferred agent for Pneumocystis pneumonia prophylaxis. Furthermore, trimethoprim-sulfamethoxazole provides protection against Toxoplasma encephalitis and may provide some benefit in preventing further episodes of community-acquired pneumonia. Patients with a history of a mild-to-moderate rash caused by trimethoprim-sulfamethoxazole can often undergo successful trimethoprim-sulfamethoxazole desensitization.


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