Pneumocystis carinii pneumonia

Risk group

Lymphoid malignancy long-term treatment esp. ALL, steroid usage, purine analogues e.g. fludarabine and 2-CDA.

Treatment

High dose cotrimoxazole IV initially—watch renal function and adjust dose to creatinine. Give short pulse of steroid 0.5mg/kg at start of treatment. At-risk patients should remain on long-term prophylaxis until chemo finished and absolute CD4 lymphocyte count >500 X 106/L. Use cotrimoxazole 480mg bd on Monday, Wednesday and Friday only, provided neutrophil count maintained >1.0 x 109/L. Otherwise use nebulised pentamidine 300mg every 3 weeks with preceding nebulised salbutamol 2.5mg.

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