Infection-related management for immunosuppressed patients:
I. Prevention: Prophylactic medication before symptoms appear
1.1 Bacteria
There is currently no evidence-based medicine supporting routine prophylaxis. Clinical monitoring of blood counts is conducted, and symptomatic treatment is given upon abnormal findings.
1.2 Viruses
Vaccination is widely used as a preventive measure (patients should be re-vaccinated regardless of previous vaccination history).
1.2.1 For patients positive for HBsAg and anti-HBc, use antiviral drugs (e.g., entecavir) for at least 12 months.
1.2.2 For HSV (Herpes Simplex Virus) IgG positive patients, antiviral drugs are administered from the start of treatment until four weeks after stopping immunosuppressants.
1.2.3 For CMV (Cytomegalovirus) IgG positive patients, viral PCR testing is performed every 1-3 months during the treatment period.
1.3 Fungi
1.3.1 For PcP (Pneumocystis pneumonia): sulfonamide antibiotics: 800mg bid, twice a week.
More PcP-related content can be found in 阙咏图, 李鹏冲, 张奉春. Research Progress on Using Compound Sulfamethoxazole for Preventing Pneumocystis Pneumonia in Patients with Autoimmune Diseases[J]. Xiehe Medical Journal, 2023, 14(1): 196-202. DOI: 10.12290/xhyxzz.2022-0131
1.3.2 Other primary fungal infections: use fluconazole 400 mg/d tid.
II. Treatment: For infections without prophylaxis or breakthrough infections
2.1 Bacteria
2.1.1 Gram-negative bacteria: use third-generation cephalosporins. Refer to the “Guidelines for Diagnosis and Treatment of Gram-negative Bacterial Infections” for details.
2.1.2 Gram-positive bacteria: glycopeptides, oxazolidinones, lipopeptides.
2.2 Mycoplasma/Chlamydia
In areas with low resistance, macrolides (azithromycin) can be used; in areas with high resistance, use tetracyclines or respiratory quinolones.
2.3 Viruses
2.3.1 HHV (Human Herpesvirus): DNA polymerase inhibitors
2.3.2 HBV: nucleoside analogues (entecavir)
2.3.3 SARS-CoV-2: azvudine; refer to the “Novel Coronavirus Infection Treatment Protocol” for details.
2.4 Opportunistic Infections
2.4.1 Invasive fungi: azoles, echinocandins, polyenes
2.4.2 Mycobacteria: anti-tuberculosis treatment