Recently updated the pneumocystis pneumonia chapter, here are my top three pearls from the PJP literature π€
π§΅#1/4β¦
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π§΅#1/4β¦
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#1) 10 mg/kg TMP-SMX is prob adequate for pneumocystis.
good choice esp if you suspect PJP & want to cover (but minimize toxicity)
remember: TMP-SMX 10 mg/kg covers lots of bacteria too
doxy + TMP/SMX + 60 mg/d prednisone is often a good choice for wierd PNA/pneumonitis
good choice esp if you suspect PJP & want to cover (but minimize toxicity)
remember: TMP-SMX 10 mg/kg covers lots of bacteria too
doxy + TMP/SMX + 60 mg/d prednisone is often a good choice for wierd PNA/pneumonitis
#2) increasing evidence that induced sputum PCR has high sensitivity.
so if you want to exclude PJP but youβre not worried about other opportunists, induced sputum may be a good option.
not every PJP ruleout needs an immediate bronch - thereβs a whole strategy behind this
so if you want to exclude PJP but youβre not worried about other opportunists, induced sputum may be a good option.
not every PJP ruleout needs an immediate bronch - thereβs a whole strategy behind this
#3) patients with chronic severe lymphopenia are at risk of PJP.
PJP may occur with immune *reconstitution*, so the admission Ly count might not tell the whole story
if you see a complex pt with cancer or rheum dz whose Ly count has been super low for months then think PJP
PJP may occur with immune *reconstitution*, so the admission Ly count might not tell the whole story
if you see a complex pt with cancer or rheum dz whose Ly count has been super low for months then think PJP
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