PJP prophylaxis

Mortality 30-50% non HIV infected, 50-80% mortality if admitted to ICU

Co-Trimoxazole

SE: leukopaenia, myelosuppression, rash, SJS, hepatitis, nephropathy: AIN, crystallopathy, Artefactual increase in Cr due to secretary impairment.

Reduced dose regimes have less side effects and similar prophylactic cover e.g 1 2 3

Benefits of cotrim beyond PJP- broad spectrum antibacterial cover

TMP/SMX prophylaxis lower associated on severe infection (HR 0.3, 95% CI 0.13-0.69 over 24 months in ritux treated AAV, in particular Resp infections.

TRIAL	Prophylaxis	PJP rate
MENTOR	Yes	0
TESTING	No	2.2%
MAINTISAN	Yes	1.75%
EXPLORER	No	0

Alternative: dapsone – G-6-PD and methhaemoglobinaemia/hemolysis.

Who gets prophylaxis (GN)

• Dual treatment (e.g. b cell/cyclophos + pred) – always.
• Ritux alone – I think so. Rituximab In Non hodkins lymphoma in Taiwan, ritux alone increases PJP (2.95% vs 1.32)
• SLE – in MMF only, probably not, but if increased risk, then use. Err on the side of caution.
• Duration unclear, certainly while on active treatment, and if higher risk, run for 6 months post de-escalation. Some may need life long.