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A 38-year-old man is admitted to the hospital with a 1-week history of progressive dyspnea, cough, and low-grade fever. He has a history AIDS and has found it difficult to take all of his medications. His CD4 count measured 6 months ago was 80/μL. He has no allergies.
On examination, he appears dyspneic. Temperature is 39.2°C (102.5°F), blood pressure is 110/70 mm Hg, pulse rate is 110/min, and respiration rate is 32/min. Oxygen saturation by pulse oximetry is 82% on ambient air. Cardiopulmonary examination is normal.
Arterial blood gas results are: pH, 7.41; PO2, 58 mm Hg (7.7 kPa); PCO2, 32 mm Hg (4.3 kPa); HCO3, 20 meq/L (22 mmol/L). Chest x-ray revealed bilateral interstitial infiltrates. A silver stain of induced sputum is positive for Pneumocystis jirovecii.
Which of the following is the best initial treatment regimen for this patient?
(A) Dapsone
(B) Dapsone plus corticosteroids
(C) Trimethoprim-sulfamethoxazole
(D) Trimethoprim-sulfamethoxazole plus corticosteroids
A 38-year-old man is admitted to the hospital with a 1-week history of progressive dyspnea, cough, and low-grade fever. He has a history AIDS and has found it difficult to take all of his medications. His CD4 count measured 6 months ago was 80/μL. He has no allergies.
On examination, he appears dyspneic. Temperature is 39.2°C (102.5°F), blood pressure is 110/70 mm Hg, pulse rate is 110/min, and respiration rate is 32/min. Oxygen saturation by pulse oximetry is 82% on ambient air. Cardiopulmonary examination is normal.
Arterial blood gas results are: pH, 7.41; PO2, 58 mm Hg (7.7 kPa); PCO2, 32 mm Hg (4.3 kPa); HCO3, 20 meq/L (22 mmol/L). Chest x-ray revealed bilateral interstitial infiltrates. A silver stain of induced sputum is positive for Pneumocystis jirovecii.
Which of the following is the best initial treatment regimen for this patient?
(A) Dapsone
(B) Dapsone plus corticosteroids
(C) Trimethoprim-sulfamethoxazole
(D) Trimethoprim-sulfamethoxazole plus corticosteroids