Case Studies

DECEMBER 12, 2011
Craig I. Coleman, PharmD

Case One

 Dosing for Bactrim PJ is a 37-year-old HIV-infected man who comes to the pharmacy with a new prescription for Bactrim (trimethoprim and sulfamethoxazole)—1 double-strength tablet daily for prophylaxis of pneumocystis pneumonia (PCP). PJ’s CD4 count is 177 cells/mcL. PJ has been filling prescriptions for antiretroviral therapy at the pharmacy for many years. While filling the Bactrim prescription, the pharmacist recalls a prescription he filled for an HIV-infected patient requiring PCP prophylaxis a few weeks back for Bactrim 1 single-strength tablet daily. The pharmacist begins to question what the correct dose of Bactrim is for this indication.

What is the appropriate dose of Bactrim for this indication?


Case Two: Adjuncts to Peginterferon Alfa-2a Therapy JC is a 32-year-old man with hepatitis C whose liver biopsy shows chronic hepatitis with significant fibrosis. His physical exam and blood work show he does not have decompensated liver disease (marked by hepatic encephalopathy or ascities) or abnormalities on his complete blood count or metabolic chemistry panel. JC has no other comorbidities. He was just seen by a physician and a pharmacist at the clinic he attends, and the physician decided to start peginterferon alfa-2a (180 mcg subcutaneously once weekly) and ribavirin (1200 mg, because JC weighs 82 kg). The pharmacist knows that fewer than 50% of patients will respond to therapy.

Is there anything the pharmacist could recommend be added to peginteferon alfa-2a and ribavirin to increase JC’s chances of a positive outcome? 







Dr. Coleman is associate professor of pharmacy practice and director of the pharmacoeconomics and outcomes studies group at the University of Connecticut School of Pharmacy.

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