PJP prophylaxis — SCE Rheumatology MCQ

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ModerateRheumatological PharmacologyPJP prophylaxisSCE Rheumatology

A 71-year-old man with GPA will receive cyclophosphamide and prednisolone 60 mg daily. He has lymphopenia and chronic lung disease. He has no allergy to co-trimoxazole and renal function is stable. What is the most appropriate management?

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Correct answer: E — Start co-trimoxazole prophylaxis unless contraindicated

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

Start co-trimoxazole prophylaxis unless contraindicated is best because co-trimoxazole prophylaxis reduces Pneumocystis risk during intensive AAV immunosuppression. B is less suitable because live intranasal influenza vaccine is inappropriate during major immunosuppression and is a vaccine not PJP prophylaxis; C is less suitable because colchicine prevents gout flares; D is less suitable because ANCA positivity does not protect against opportunistic infection; E is less suitable because aspirin does not prevent PJP. Clinical pearl: PJP risk is driven by the treatment regimen as much as the underlying disease.

Reference: EULAR infection prophylaxis recommendations; BNF