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PJP prophylaxis during vasculitis induction — ESENeph MCQ

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ModerateTherapeutics and Safe PrescribingPJP prophylaxis during vasculitis inductionESENeph

A 41-year-old man with newly diagnosed granulomatosis with polyangiitis is starting cyclophosphamide and high-dose prednisolone. eGFR is 48 mL/min/1.73 m² and lymphocyte count is normal. He has no sulfonamide allergy. What additional medication is most appropriate?

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Correct answer: B — Co-trimoxazole prophylaxis for Pneumocystis jirovecii

High-dose corticosteroid plus cyclophosphamide for vasculitis confers significant Pneumocystis risk, so co-trimoxazole prophylaxis is commonly used when not contraindicated. Ciprofloxacin and amphotericin do not prevent Pneumocystis. Aciclovir may be used for herpes risk in selected settings but is not a substitute for PJP prophylaxis. The pearl is that infection prevention is part of immunosuppression prescribing, alongside vaccination review and monitoring.

Reference: KDIGO 2024 ANCA Vasculitis Guideline; BNF