PJP Prophylaxis Failure — SCE Infectious Diseases MCQ

Correct answer: D — Start secondary co-trimoxazole prophylaxis and retain it while material immunosuppression persists, using an alternative only if co-trimoxazole is unsuitable after review

The best answer is “Start secondary co-trimoxazole prophylaxis and retain it while material immunosuppression persists, using an alternative only if co-trimoxazole is unsuitable after review”. A prior episode plus continuing immunosuppression creates high recurrence risk; prophylaxis duration follows immune risk rather than a fixed short interval. “Use no prophylaxis after successful treatment” does not match the decisive clinical feature or cited guidance. “Reserve prophylaxis for people with HIV” does not match the decisive clinical feature or cited guidance. “Reduce rituximab alone instead of preventing recurrence” does not match the decisive clinical feature or cited guidance. “Use dapsone in every patient regardless of G6PD status or co-trimoxazole tolerance” does not match the decisive clinical feature or cited guidance.

Reference: ECIL Pneumocystis prophylaxis guideline: https://pubmed.ncbi.nlm.nih.gov/27550992/