23 year old male with HIV presents with 1 week of fever, cough with yellow sputum, malaise presents with worsening of symptoms. Patient has vital signs of T103, P110, BP135/89, sat 90% on RA. Physical exam reveals coarse rhonchi bilaterally. His initial pa02 is 78 mm Hg. Below is the chest x-ray.

Pcp Pna2

 

Pcp

 

What is the next initial management after starting IV TMP-SMX?

A. Corticosteroids

B. Intubate

C. Continue supportive care

D. Start antiretroviral therapy

Severe PCP is defined as arterial PaO2<60 mmHg on air. Moderate PCP is defined as: PaO2 between 60 and 80 mmHg on air. Corticosteroid therapy should be considered in patients with paO2 below 70 mmHg. ART should be initiated after two weeks of initial dose of TMP-SMX for ART naive patients. ART in patients already on their course should continue.