Basic Immunosuppression Prophylaxis Protocols

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A quick & dirty guide for what kidney transplant patients should be on for prophylaxis:

1. PCP Prophylaxis: should be given to all patients for as long as they are on steroids. The standard is Bactrim SS given once per day (or given every other day for those with GFR less than 30 ml/min).

2. CMV Prophylaxis: I know that different transplant centers have different protocols for which antiviral agent is used for CMV prophylaxis, with choice of agent based on the CMV donor/recipient status. We tend to use valgancyclovir (Valcyte) most commonly given at 450mg po qd (or 450mg po qod if GFR less than 30.)

3. oral candidiasis: nystatin swish/spit is usually sufficient to prevent this.

4. Strongyloides: patients who are from an endemic area can be given ivermectin 200mcg/kg po x 2 doses which is highly effective.

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