What is the recommended prophylaxis for Pneumocystis pneumonia (PCP) in a patient with a CD4 count less than 200?

For a patient with a CD4 count less than 200 cells/mm³, the recommended prophylaxis for Pneumocystis pneumonia (PCP) is trimethoprim-sulfamethoxazole, commonly known as Bactrim. This antibiotic combination is highly effective in preventing PCP, which is a significant opportunistic infection in individuals with HIV/AIDS whose immune systems are severely compromised. The use of Bactrim has been well-studied and established as the standard of care in this population.

In cases where patients may not tolerate Bactrim due to allergies or adverse effects, alternatives such as dapsone or atovaquone can be considered. However, these alternatives are generally not first-line options and are used in specific situations where Bactrim cannot be given. Azithromycin does not provide effective prophylaxis against PCP and is not appropriate for this indication. The established guidelines prioritize Bactrim for its proven efficacy and safety profile in preventing PCP in high-risk patients.