A nurse reviews the discharge medication list for a kidney transplant client. Which prophylactic regimen reflects standard care to prevent opportunistic infections?
1Trimethoprim-sulfamethoxazole for PCP/UTI prophylaxis, valganciclovir for CMV (if D+/R-), nystatin oral suspension for Candida, ± isoniazid if latent TB; vaccination updates as appropriate✓ Correct answer
2Daily IV vancomycin
3No prophylaxis needed
4IV chemotherapy
Explanation
Correct (2): Post-transplant prophylaxis: TMP-SMX for PCP and UTI (6-12 months), valganciclovir for CMV (3-6 months in D+/R- mismatch), nystatin/clotrimazole for oropharyngeal Candida (1-3 months), isoniazid for latent TB. Live vaccines contraindicated; inactivated only after 3-6 months. (1,3,4) Incorrect.
In-depth explanation
Memory Tip Transplant prophylaxis = "Bactrim·Valgan·Nystatin" first 3-12 months. AVOID live vaccines (MMR, varicella, yellow fever, live influenza, oral polio). Inactivated OK after 3-6 months.
Clinical scenario
Scenario 40-year-old female 1 week post-kidney transplant; pre-discharge med reconciliation.
Key concepts
TMP-SMX prophylaxis — Prevents PCP and UTI in transplant recipients; usually 6-12 months post-transplant.