Antimicrobial prophylaxis for patients taking immunomodulatory drugs
The optimal approach to antimicrobial prophylaxis for patients taking immunomodulatory drugs for autoimmune or autoinflammatory disorders is not known; the following recommendations offer a practical approach based on expert consensus. The decision to start antimicrobial prophylaxis should be made by a specialist.
A person’s degree of immunosuppression can be influenced by multiple factors, including:
- the immunomodulatory drug(s) used
- the intensity of the drug regimen
- current disease activity.
Guidance on when to give antimicrobial prophylaxis (eg Pneumocystis jirovecii pneumonia [PJP] prophylaxis) for patients taking corticosteroids or specific immunomodulatory drugs is addressed here. In particular, patients with pulmonary manifestations of their condition have a significantly increased risk of developing PJP compared to patients without pulmonary manifestationsHsu, 2021.
Specific advice on prophylaxis for some drugs is available in the Antibiotic guidelines, including: