Management of PCP has improved over the past decades: chemoprophylaxis is used routinely during periods of immunological susceptibility in various patient populations, and if an episode of PCP does occur, the prognosis is improved because of earlier diagnosis and earlier institution of therapy. The use of adjunctive corticosteroid treatment for moderate to severe PCP has also led to a decrease in mortality.
Few advances in drug treatment have occurred during the past 20 years. The major chemotherapeutic agents available for treatment of PCP in the pre-HIV era were parenteral pentamidine and trimethoprim sulfamethoxa-zole (TMP-SMX). To date, TMP-SMX remains the drug of choice for both treatment and prophylaxis of PCP because of its well-established safety and efficacy, as well as its low cost. Alternatives, if the patient is intolerant or fails TMP-SMX, include dapsone-containing regimens, pentamidine (intravenous form for treatment and aerosolized form for prophylaxis), atovaquone, and clindamycin/ primaquine (treatment only).
The oral route can be used to treat mild to moderate cases of PCP when no obvious gastrointestinal dysfunction is apparent. All patients with severe disease should be placed on an intravenous regimen and should receive adjunctive corticosteroid therapy.
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The use of dumbbells gives you a much more comprehensive strengthening effect because the workout engages your stabilizer muscles, in addition to the muscle you may be pin-pointing. Without all of the belts and artificial stabilizers of a machine, you also engage your core muscles, which are your body's natural stabilizers.