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PJP Prophylaxis in Non-HIV — SCE Infectious Diseases MCQ

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HardImmunocompromised HostPJP Prophylaxis in Non-HIVSCE Infectious Diseases

A patient without HIV recovers from proven Pneumocystis jirovecii pneumonia while taking prednisolone 20 mg/day plus azathioprine for sarcoidosis. Both immunosuppressants must continue. What is the best secondary-prevention plan?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Use co-trimoxazole prophylaxis without a preset stop date and reassess when the immunosuppressive regimen changes

Explanation lettering: E = shown as A · A = shown as B · B = shown as C · C = shown as D · D = shown as E

D is correct: secondary prophylaxis is maintained while the non-HIV immunosuppressive risk persists. A and E ignore high recurrence risk. B imposes an arbitrary stop date. C extrapolates an HIV CD4 rule and a fixed course without addressing ongoing dual immunosuppression.

Reference: ECIL non-HIV Pneumocystis guideline: https://pubmed.ncbi.nlm.nih.gov/27550993/