tailieunhanh - Mayo Clinic Antimicrobial Therapy quick guide - part 10

Nhiễm trùng ở bệnh nhân HIV đầu điều trị thay thế điều trị bệnh nặng: pentamidine 3-4 mg / kg IV q24h nhẹ đến trung bình bệnh: clindamycin 600-900 mg IV q8h (hoặc clindamycin 300-450 mg uống tid qid) cộng với primaquine 1530 mg uống q24h hoặc dapsone 100 mg tmp uống q24h cộng với 5 mg / kg uống q8h; atovaquone uống 750 mg thầu | Table 79. Treatment and Prophylaxis of Pneumocystis jiroveci Infections in HIV Patients Antimicrobial therapy First-line treatment Alternate treatment Treatment of active disease usually 21-day duration tmp smx IV 15 mg kg 24h tmp component in divided doses q6-8h for 21 days consider serum level monitoring If l a 2 70 mm Hg or alveolar-arterial oxygen gradient 35 mm Hg add prednisone 40 mg bid for 5 days then 40 mg q24h for 5 days til en 20 mg q24h for 11 days Severe disease pentamidine 3-4 mg kg IV q24h Mild to moderate disease clindamycin 600-900 mg IV q8h or clindamycin 300-450 mg oral tid or qid plus primaquine 15-30 mg oral q24h or dapsone 100 mg oral q24h plus tmp 5 mg kg oral q8h or atovaquone 750 mg oral bid or trimetrexate mg kg IV q24h plus leucovorin mg kg oral qid or tmp smx DS 2 tab tid Prophylaxis primary or secondary tmp smx 1 DS or SS tab daily dapsone 100 mg oral q24h or 50 mg oral bid or dapsone 50 mg oral q24h plus pyrimethamine 50 mg oral once weekly plus leucovorin 25 mg oral weekly or dapsone 200 mg oral weekly plus pyrimethamine 75 mg oral weekly plus leucovorin 25 mg oral weekly or atovaquone 1 500 mg oral q24h or tmp smx 1 DS tab 3 x wk or pentamidine 300 mg Inh monthly 297 Infectious Syndromes Infectious Syndromes 298 Toxoplasma gondii Encephalitis Risk factors CD4 100 mcL greatest risk with CD4 50 mcL usually represents reactivation IgG seropositive primary disease risk factors are undercooked meat and exposure to cat feces Clinical disease 1 Most common presentation is focal encephalitis 2 Computed tomogram CT or magnetic resonance imaging MRI typically shows multiple contrastenhancing lesions 3 Immune reconstitution syndrome can be seen corticosteroids or NSAIDS may help Criteria for starting primary prophylaxis Initiate with CD4 100 mcL and IgG antibody positive for Toxoplasma gondii Criteria for stopping prophylaxis Adequate response to HAART and 1 For primary prophylaxis CD4 200 mcL for 3 months 2 For secondary prophylaxis .