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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