Is secondary prophylaxis or maintenance therapy required after treatment of the acute episode of PCP?
All patients with a CD4 count of <200 cells/mm3 should receive primary prophylaxis to prevent PCP. All patients who have experienced an episode of PCP should receive secondary prophylaxis to prevent a recurrence of PCP. Prophylaxis should be continued for life unless immune recovery occurs with ART. Prophylaxis for PCP should be discontinued if the CD4 count increases to levels of >200 cells/mm3 and is sustained for at least 3 months. Prophylaxis should be restarted if the CD4 count declines to <200 cells/mm3 or if PCP recurs regardless of CD4 cell count. Table 9-3 summarizes recommended and alternative regimens for primary and secondary prevention of PCP. It should be noted that TMP-SMX and dapsone plus pyrimethamine are also adequate for prevention of toxoplasmosis in susceptible individuals; dapsone alone, atovaquone alone, and aerosolized pentamidine are not.
Related Questions
- A pilot study of steroid therapy after emergency department treatment of acute asthma: is a taper needed?
- Is secondary prophylaxis or maintenance therapy required after treatment of the acute episode of PCP?
- What is the role of maintenance therapy in the standard treatment of patients with ovarian cancer?
