Antimicrobials: cotrimoxazole for Pneumocystis: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Antimicrobials: cotrimoxazole for Pneumocystis

Sample item

An HIV-positive patient with CD4 count 60 per microlitre has dry cough, exertional dyspnoea and bilateral ground-glass infiltrates, and Pneumocystis jirovecii is confirmed. What is the drug of choice?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Cotrimoxazole, with corticosteroids if hypoxic

High-dose cotrimoxazole is the drug of choice for Pneumocystis pneumonia and also for Nocardia. Adjunctive steroids are given if the arterial oxygen is low. Primary prophylaxis is given below a CD4 count of 200.

Option by option

  • A. Cotrimoxazole, with corticosteroids if hypoxic (correct)

    Correct. Cotrimoxazole is first-line.

  • B. Azithromycin

    Azithromycin is not the treatment for PCP.

  • C. Amphotericin B

    Amphotericin B is not first-line for PCP.

  • D. Fluconazole

    Fluconazole does not act against Pneumocystis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is A, Cotrimoxazole, with corticosteroids if hypoxic. High-dose cotrimoxazole is the drug of choice for Pneumocystis pneumonia and also for Nocardia.

Why is "Azithromycin" not the answer?

Azithromycin is not the treatment for PCP.

Why is "Amphotericin B" not the answer?

Amphotericin B is not first-line for PCP.

Why is "Fluconazole" not the answer?

Fluconazole does not act against Pneumocystis.

What concept does this question test?

It tests Antimicrobials: cotrimoxazole for Pneumocystis in Pharmacology. Adjunctive steroids are given if the arterial oxygen is low. Primary prophylaxis is given below a CD4 count of 200.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Antimicrobials: cotrimoxazole for Pneumocystis?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.