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Neuromuscular respiratory failure — SCE Respiratory MCQ

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HardRespiratory FailureNeuromuscular respiratory failureSCE Respiratory

A patient with moderate-to-severe HIV-associated Pneumocystis pneumonia develops a severe co-trimoxazole reaction requiring a change of antimicrobial. G6PD activity is normal. Which BHIVA-supported alternative is appropriate?

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

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Correct answer: C — Clindamycin with primaquine, using intravenous clindamycin initially when severe

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

E is correct. BHIVA supports clindamycin plus oral primaquine as an alternative for both mild-to-moderate and moderate-to-severe PCP; intravenous clindamycin can be used initially in severe disease, and G6PD status must be checked before primaquine. Nebulised pentamidine is inadequate for severe established infection, while fluconazole, rifampicin–ethambutol and caspofungin monotherapy do not constitute validated PCP replacement regimens. Adjunctive corticosteroid is continued when the oxygenation criterion is met, independently of the antimicrobial switch.

Reference: https://bhiva.org/wp-content/uploads/2024/10/OI-guidelines-Pulmonary.pdf