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25- Prophylaxis

 

 

TB

  • Nonsense for dying patients.  (See29-Resistance and Contamination)
  • For workers at our hospice TB is really the main danger!  Use masks during work, eat good food, exercise, rest well and have regular check-ups...  For prophylactic drugs: take only on advice of TB specialist.

PCP

  • Bactrim 1tab daily for the rest of life if patient already has candidiasis in mouth (CD4<200).  BUT protection is not absolute!!!
    •  
    • If patient is allergic to sulfa, give dapsone 100mg daily.
    •  
  • If patient has already had PCP in past, prophylaxis is the same.
  • (For workers, no danger so no prophylaxis necessary.)

Prophylaxis is not need for patients receiving toxoplasmosis treatment.

TOXOPLASMOSIS

  • Protection with Bactrim 1tab 2x/day.  BUT protection is not absolute!!!
    •  
    • If patient is allergic to sulfa, give dapsone 50mg/day + pirymethamine 25mg 2days/week, plus folic acid 25mg/week
    •  
  • If patient has already had Toxoplasmosis in past, Bactrim is useless.  After he receives a full curative treatment (6weeks), you should give sulfadiazine 500mg 4 times a day plus pyrimethamine 25mg 2days/week, plus folic acid 25mg/day
    •  
    • In case of allergy... prophylaxis becomes too expensive!  (clindamycin 300mg x 3 daily + pyrimethamine 25mg daily + folic acid 25 mg daily
    •  
  • (For workers, no danger so no prophylaxis necessary.)

…  In practice this results often in too many drugs to take …given the situation at the hospice we feel sometimes it is strategically better not to give prophylaxis (treatment is easy and fast acting).

Patients receiving PCP treatment do not need toxo prophylaxis of course

CRYPTOCOCCOSIS

Protection is now less expensive (generics).  But main danger is in creating resistance (candidas and other very common mycosis as well)

  • Fluconazole 200mg 3 days/week.  Since we started that prophylaxis we have not had resistant candidas in our wards... and we have saved extra expense of curing candidas!)
  • If patient has already had Cryptococcosis in the past he need fluconazole 200mg daily if infection occurred long ago, 1tab 2x/day if just had acute episode or still has suspicious headache.
  • For workers, no danger so no prophylaxis necessary.

MAC (mycobacterium avium complex)

  • Prophylaxis is too expensive...

CMV (cytomegalovirus)

  • Prophylaxis is too expensive...

 

 

 

 

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paul yves wery - aidspreventionpro@gmail.com

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