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39 Cards in this Set

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When to initiate pneumocystis treatment
<200
Treatment duration for pneumocystis
21 days
Pneumocystis 1st line tx
TMP/SMX 15-20mg/kg/day in 3-4 divided doses

or 2 DS tabs PO Q8H
Pneumocystis 2nd line tx
Dapsone 100mg Q24H and TMP/SMX 15-20mg/kg/d PO
Pneumocystis other alternative treatments
-Clindamycin + Primaquine

-Atovaquone (mild-mod)

-Pentamidine (severe-last line)

-Trimetrexate + leucovorin
When do you initiate adjunctive corticosteroid treatment for hypoxia? Which corticosteroid do you use?
PaO2 <70mmHg

Alveolar-arterial O2 gradient >35mmHg

Prednisoneor methylpredinisolone x21 days
Pneumocystis indications for primary prophylaxis
i.CD$+<200 OR
ii. hx of oropharyngeal candidiasis
Pneumocystis primary prophylaxis 1st line
TMP/SMX 1 ss tab Q24H
OR
TMP/SMX 1 DS TIW
Pneumocystis primary prophylaxis 2nd line alternatives
Dapsone 100mg PO Q24H
OR
Dapsone 200mg PO QWK +++ Pyrimethamine 50mg PO QWK +++ Leucovorin 25mg PO QWK

Also aerosolized pentamidine qmonthly, or atovaquone
When is secondary prophylaxis for pnemocystis started?
When treatment course ends

Identical to primary prophylaxis regimens
HIV patients are at risk of MAC infection at what CD4+ count?
<100
MAC initial treatment
*Azithromycin 500mg PO Q24H
PLUS
Ethambutol 15mg/kg PO Q24H

For SEVERE DX, ADD Rifabutin 300mg PO Q24H


(*or Clarithromycin 500mg PO Q12H)
If a patient does not respond after 2-4 weeks of therapy, add what?
i.Ciprofloxacin 750mg PO Q12H
OR
Levofloxacin 500mg PO Q12H

ii. Amikacin 15mg/kg IV Q24H
Most patients receive treatment for MAC for life, unless they meet what requirement?
Treated for atleast 12 months
AND
Asymptomatic
AND
CD4+ >100 for 3-6 months
When is primary prophylaxis indicated for MAC?
<50
MAC primary prophylaxis treatment and alternative
*Azithromycin 1200mg PO QWEEKLY

Alternative: Rifabutin 300mg PO Q12H

*(Clarithromycin 500mg Q12H)
When should primary prophylaxis be discontinued ?
When CD4>100 for 3 months
Secondary prophylaxis for MAC
Not recommended
Patients at highest risk for Toxoplasmosis have a CD4+ count of what?
<100
What is the treatment duration for Toxoplasmosis?
Treat for atleast 6 WEEKS followed by life long SECONDARY PROPHYLAXIS
Toxoplasmosis preferred treatment
Pyrimethamine 200mg PO x1, then 50mg (<60kg) or 75mg Q24H
PLUS
*Sulfadiazine 1g (<60kg) or 1.5g Q24H either PO/IV given in FOUR DOSES
PLUS
Lecuovorin (folinic acid) 10-20mg PO Q24H

*Alternatives:
Clindamycin 600mg PO/IV Q6H OR Clarithromycin 1g PO Q12H OR Azithromycin 1.2-1.5g PO Q24H OR Dapsone 100mg po Q24H
When is primary prophylaxis for Toxoplasmosis indicated?
<100 PLUS +toxo IgG
Primary prophylaxis 1st line treatment and alternatives
TMP/SMX 1 DS tab Q24H

Alternatives:
-TMP/SMX 1 ss tab Q24H
-Pyrimethamine 50mg QWEEK AND Dapsone 50mg Q24H AND Leucovorin
Secondary prophylaxis for Toxoplasmosis
Sulfadiazene PLUS
Pyrimethamine PLUS
Leucovorin

Alternative: Clindamycin PLUS Pyrimethamine PLUS Lecuovorin
Oropharyngeal candidiasis initial episode treatment
i. Clotrimazole troches 10mg PO 5 TIMES DAILY
ia. Nystatin suspension 4-6mL q6H

ii. Fluconazole 100mg PO q24H
Treatment for Fluconazole refractory OC?
a. Itraconazole oral solution
b. Amphoterecin B
Treatment for Esophageal candidiasis
i. Fluconazole 100-400mg PO/IV Q24H
Treatment for Fluconazole refractory EC
a. Caspofungin
b. Amphoterecin B
c. LIpid amphoterecin B
Prophylaxis for OC and EC?
Not recommended

-fluconazole
Immediate vision threatening lesion treatment for CMV
Intraocular ganciclovir implant
PLUS
Valganciclovir 900mg PO Q24H
How often should the intraocular ganciclovir implant be changed?
Q6-8H
How long does treatment of CMV last?
Until inactive dx
PLUS
CD4+ >100 x 3-6months
CMV retinitis treatment
Ganciclovir x14-21days OR valganciclovir x14-21days OR
foscarnet x14-21days OR cidofovir x2weeks then w/ probenecid and vigorous hydration
CMV esophagitis treatment
treatment lasts 14-21 days; consider maintenance after relapse
-Ganciclovir OR Valganciclovir OR foscarnet OR cidofovir w/ probenecid and vigorous hydration
CMV colitis treatment
same as CMV esophagitis
CMV penumonitis treatment
same as CMV esophagitis
CMV neurological disease treatment
Ganciclovir x14-21days PLUS foscarnet 14-21 days
TB treatment
Isoniazid PLUS Rifampin PLUS Pyrazinamide + Ethambutol + Pyridoxine

ADD streptomycin for suspected multi-drug resistant isolates

After 2months, stop pyrazinamide and continue isoniazid/rifampin for remaining 6months
TB prophylaxis for HIV+ patients with +PPD
Isoniazid 300mg x9monhts
OR
rifampin and pyrazinaide x2months