Value of anti-infective chemoprophylaxis in primary systemic vasculitis: what is the evidence?

Table 2 Possible use of anti-infective chemoprophylaxis in primary systemic vasculitis patients

Infectious agent	Prophylactic measure	Appropriate clinical situation	Level of evidence
Pneumocystis jiroveci	Trimethoprim/sulfamethoxazole 960 mg thrice weekly. Alternative: monthly aerolized pentamidine (300 mg)	Should be given to all patients receiving long term glucocorticoid >15 mg/day and additional intense immunosuppression	B to C
S. aureus	Nasal mupirocin ointment three times daily for 7 consecutive days per month	Might be given to patients with generalized SVV who are S. aureus carriers during induction of remission	C
Mycobacterium tuberculosis	Isoniazid 5 mg/kg per day up to 300 mg plus pyridoxin (vitamin B6). Alternative: rifampin 10 mg/kg per day up to 600 mg	If latent tuberculosis is detected and immunosuppression necessary, especially when infliximab is used	C
Varicella-zoster virus	Aciclovir 2 × 800 mg per day	Generally not recommended, but might be considered in very selected cases with several reactivations and ongoing need for intense immunosuppression	C
	Zoster vaccine	Not recommended	C
Cytomegalovirus	Valganaciclovir 1 × 900 mg per day	Not generally recommended, but might be considered in selected severe cases with earlier reactivations and ongoing need for intense immunosuppression	C
Aspergillus sp.	For example, posaconazole	Not recommended	C
Candida sp.	Oral amphotericin B suspension, 4 × 1 ml (= 100 mg) per day	Should be considered in patients with long term glucocorticoid therapy >15 mg/day	C

Level of evidence: A = evidence from at least one properly performed randomized controlled trial or meta-analysis of several controlled trials; B = well-conducted clinical studies, but no randomized clinical trials - evidence may be extensive but essentially descriptive; C = evidence obtained from expert committee reports or opinions, and/or clinical experience of respected authorities.

ISSN: 1478-6362