Pcp prophylaxis steroid use

In a phase II clinical trial, Martinez et al (2009) examined the safety and effectiveness of alemtuzumab in treating steroid-refractory acute GVHD (aGVHD) grade II or higher after stem cell transplantation.  A total of 10 adult patients (6 with aGVHD grade III and 4 with aGVHD grade IV) were included in the study.  Nine patients had gastrointestinal tract involvement, 7 had skin involvement, and 5 had liver involvement.  Five patients responded to treatment, 2 with CR and 3 with partial response.  Eight infectious events (4 of grade 3 to 4) and 7 CMV re-activations were observed.  Six patients had grade 3 to 4 cytopenia.  All 10 patients died (7 resulting from aGVHD progression, 2 from severe infection, and 1 from to leukemia relapse), at a median of 40 days (range of 4 to 88 days) after alemtuzumab treatment.  Overall, these findings suggested that steroid-refractory aGVHD may be improved by treatment with alemtuzumab, but that this treatment does not overcome the dismal prognosis of patients with severe aGVHD, demonstrating the need for alternative therapies to treat this complication.

Thyroid storm is a life-threatening condition of the hyperthyroid state. 26 It most commonly occurs in patients with Graves' disease but may also occur in those with multinodular goiter or toxic adenoma. 27 It is treated by correcting the hyperthyroidism and treating the precipitating events. 26 Correction of the hyperthyroid state involves using drugs such as propylthiouracil or methimazole (Tapazole), beta blockers or corticosteroids, which decrease the peripheral effects of thyroid hormone and the conversion of thyroxine (T 4 ) to the more potent triiodothyronine (T 3 ). 22 , 26 Dexamethasone can be used for that purpose, at a dosage of 2 mg intravenously every six hours, and can eventually can be switched to an oral dosage of 2 mg every six hours. 28

I am 50 and broke both bones on my left ankle about 1 1/2 yrs. ago. I have a plate and 7 pins on one side of my ankle and two large screws on the other side of the same ankle. I have my teeth cleaned every 3 months due to some periodontal tendencies. My orthopedic doctor’s office has given conflicting answers on whether I need to premedicate or not. I needed to have a blood transfusion a little over 2 yrs. ago, and had two pulmonary embolisms about 6 yrs ago which left my lungs compromised so I have asthma now and need to watch out that I’m not around anyone w/ pneumonia. I’ve been taking antifungal medicine for about 2 months now for some gross toenails that I’ve had for a long time.
I have premedicated for cleanings and just 5 days ago didn’t because my orthopedic doctor’s offices’ people have said it’s not necessary. I’ve heard both answers. What do you think? What should I do for the future?
How would I know if I’m having a problem w/ this issue? Will my ankle be more sore? What symptoms will clue that some bacteria has gotten into my bloodstream? In 5 more days, my dentist will be looking at removing a crown or filling a dark spot under an old crown but he won’t know what it needs until he looks at it. Would you premedicate for this? Or just for my cleanings, they do periodontal probing and check the size of the pockets,and scale my teeth and there is some blood. Should I take it just to be safe /or for peace of mind? All of the sudden I’m very worried about this. Sorry to give you all of my health history, but I don’t know if some parts are important to your response. Thanks so much.

For patients with allergy to TMP-SMX, desensitization should ideally be performed since TMP-SMX is the most effective regimen. However, if the patient has a history of a severe allergy (eg, Stevens-Johnson syndrome, toxic epidermal necrolysis), TMP-SMX should be avoided and desensitization should not be performed. (See "Treatment and prevention of Pneumocystis infection in HIV-infected patients", section on 'Desensitization for patients with a sulfa allergy' and "Sulfonamide allergy in HIV-uninfected patients" .)

Geriatric Use : Clinical studies of prednisolone sodium phosphate , USP, oral solution did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience with prednisolone sodium phosphate has not identified differences in responses between the elderly and younger patients. However, the incidence of corticosteroid-induced side effects may be increased in geriatric patients and appear to be dose-related. Osteoporosis is the most frequently encountered complication , which occurs at a higher incidence rate in corticosteroid-treated geriatric patients as compared to younger populations and in age-matched controls. Losses of bone mineral density appear to be greatest early on in the course of treatment and may recover over time after steroid withdrawal or use of lower doses (., ≤5 mg/day). Prednisolone doses of mg/day or higher have been associated with an increased relative risk of both vertebral and nonvertebral fractures, even in the presence of higher bone density compared to patients with involutional osteoporosis.

Pcp prophylaxis steroid use

pcp prophylaxis steroid use

For patients with allergy to TMP-SMX, desensitization should ideally be performed since TMP-SMX is the most effective regimen. However, if the patient has a history of a severe allergy (eg, Stevens-Johnson syndrome, toxic epidermal necrolysis), TMP-SMX should be avoided and desensitization should not be performed. (See "Treatment and prevention of Pneumocystis infection in HIV-infected patients", section on 'Desensitization for patients with a sulfa allergy' and "Sulfonamide allergy in HIV-uninfected patients" .)

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