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Chapter 28. Opportunistic Infections

IT is a male patient with a past medical history of HIV who has been taking antiretrovirals for 3 months. His CD4 count is 115 cells/mm3 and his HIV RNA is undetectable. He presents to the clinic today with odynophagia and white patches on his tongue that are easily scraped off with a tongue depressor. He is diagnosed with oropharyngeal candidiasis (first episode). Which of the following medications, available in a troche, may be used for an initial episode of oropharyngeal candidiasis?

a. Fluconazole

b. Clotrimazole

c. Itraconazole

d. Posaconazole

e. Voriconazole

Answer b is correct. Clotrimazole is effective for initial episodes of oropharyngeal candidiasis and is the only listed agent that is available in a troche formulation.

Answers a, c, d, and e are incorrect. These agents, while effective in the management of thrush, are not available in troche formulations.

Which of the agents listed below can be utilized in the management of primary prophylaxis in both PJP and toxoplasmosis? Select all that apply.

a. Atovaquone

b. Dapsone

c. Leucovorin

d. Pentamidine

e. Pyrimethamine

Answers a, b, c, and e are correct. Atovaquone, dapsone, and leucovorin are utilized in the in prophylactic management for PJP and toxoplasmosis. SMZ/TMP is the most commonly utilized agent in the management of PJP and toxoplasmosis. However, several other options can be utilized. Importantly, leucovorin may be utilized, but it is to prevent toxicity from pyrimethamine. Leucovorin prevents the bone marrow toxicity associated with pyrimethamine.

Answer d is incorrect. Pentamidine is indicated in primary prophylaxis of PJP but not toxoplasmosis.

Which of the agents listed below is given once weekly in primary prophylaxis for MAC?

a. Azithromycin

b. Aztreonam

c. Clindamycin

d. Cefazolin

Answer a is correct. Azithromycin, a macrolide, has a long half-life which allows for administration once weekly.

Answer b is incorrect. Aztreonam, a monobactam, is not indicated for primary prophylaxis of MAC.

Answer c is incorrect. Clindamycin, a lincosamide, is not indicated for primary prophylaxis of MAC.

Answer d is incorrect. Cefazolin, a first-generation cephalosporin, is not indicated in primary prophylaxis ...

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