Do you continue PJP prophylaxis indefinitely in patients on rituximab maintenance therapy?

Risk for PJP infection is usually in the context of moderate-high dose corticosteroid therapy or low T cell counts.

Some experts suggest consideration of stopping PJP prophylaxis in lower risk patients once the steroid dosage is below prednisone 10-15mg daily (PMID 29459427). A patient still on Rituximab but on minimal/no steroids and with a normal lymphocyte/CD4 count would be at lower risk.

You can assess for ly...

I don't see these patients often, but I would continue prophylaxis if the patient is still on steroids or if CD4 is low.