Correct!
3. Trimethoprim/sulfamethoxazole

All the medications have been used to treat Pneumocystis but trimethoprim/sulfamethoxazole for 21 days is the most common treatment (4). It is effective although allergies are common. In the case of allergic reactions, one of the alternatives can be used.

Our patient was treated with trimethoprim/sulfamethoxazole and had gradual respiratory improvement. Mechanical ventilation was stopped after 12 days and a subsequent CXR (Figure 6) demonstrated substantial clearing of her pulmonary infiltrates.

Figure 6. Portable chest x-ray after 12 days of therapy with sulfamethoxazole/trimethoprim.

References

  1. Cappell MS, Friedel D. Initial management of acute upper gastrointestinal bleeding: from initial evaluation up to gastrointestinal endoscopy. Med Clin North Am. 2008;92:491-509.
  2. Villanueva C, Colomo A, Bosch A, Concepción M, Hernandez-Gea V, Aracil C, Graupera I, Poca M, Alvarez-Urturi C, Gordillo J, Guarner-Argente C, Santaló M, Muñiz E, Guarner C. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med. 2013;368(1):11-21.
  3. Chastre J, Fagon JY, Trouillet JL. Diagnosis and treatment of nosocomial pneumonia in patients in intensive care units. Clin Infect Dis. 1995;21 Suppl 3:S226-37.
  4. Thomas CF Jr, Limper AH. Pneumocystis pneumonia: clinical presentation and diagnosis in patients with and without acquired immune deficiency syndrome. Semin Respir Infect. 1998;13:289-95.
  5. Castro M. Treatment and prophylaxis of Pneumocystis carinii pneumonia. Semin Respir Infect. 1998;13(4):296-303.

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