Sun28November0333PM 26

A 30-year-old male HIV positive patient is admitted with Pneumocystis jirovici pneumonia (PCP). He stopped taking co-trimoxazole therapy three weeks previously due to a rash.

Blood gases reveal:

pH 7.19 (7.36-7.44)

pCO2 5.3 kPa (4.7-6.0)

pO2 7.3 kPa (11.3-12.6)

Which of the following drug combinations would you select as treatment for this patient?

(Please select 1 option)

Rifampicin and isoniazid

Infliximab, Ticarcillin and iv pentamidine

High dose Co-trimoxazole and prednisolone Incorrect answer selected

Ciprofloxacin, metronidazole and nebulised pentamidine

Clindamycin, primaquine and prednisolone This is the correct answer

Explanation

This patient has severe PCP suggested by the pO2 below 10.

As he is allergic to co-trimoxazole alternative therapy would be IV pentamidine or clindamycin with primaquine.

Steroids have been shown to reduce mortality and prevent lung damage in people with moderate-to-severe PCP. (The severity is determined on the basis of arterial blood gas results.

These agents are used as adjunctive initial therapy only in patients with HIV infection who have severe PCP as defined by a room air arterial oxygen pressure of less than 9 kPa (70 mmHg) or an arterial-alveolar O2 gradient that exceeds 4.5 kPa (35 mmHg).

It is important that steroids be started right away if they are indicated, because their purpose is to keep people stable during those first few days of treatment. While it is true that long term steroid use is immunosuppressive a 21 day tapering course has been shown to be safe and effective.

Answer Statistics

1

4%

2

6%

3

40%

4

13%

5

40%

Times answered: 335