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Review

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

Frank Moosig*, Julia U Holle and Wolfgang L Gross

Author Affiliations

Department of Rheumatology, University Hospital of Schleswig Holstein and Klinikum Bad Bramstedt, Oskar Alexander Str. 26, 24576 Bad Bramstedt, Germany

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Arthritis Research & Therapy 2009, 11:253  doi:10.1186/ar2826

Published: 28 October 2009

Abstract

Although infections are a major concern in patients with primary systemic vasculitis, actual knowledge about risk factors and evidence concerning the use of anti-infective prophylaxis from clinical trials are scarce. The use of high dose glucocorticoids and cyclophosphamide pose a definite risk for infections. Bacterial infections are among the most frequent causes of death, with Staphylococcus aureus being the most common isolate. Concerning viral infections, cytomegalovirus and varicella-zoster virus reactivation represent the most frequent complications. The only prophylactic measure that is widely accepted is trimethoprim/sulfamethoxazole to avoid Pneumocystis jiroveci pneumonia in small vessel vasculitis patients with generalised disease receiving therapy for induction of remission.