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.

Moosig et al. Arthritis Research & Therapy 2009 11:253   doi:10.1186/ar2826