Infectious Diseases II

OI/CD4+ Threshold

for Prophylaxis

Prophylaxis Option

Treatment Option

P. jiroveci:

< 200 cells/mm3

and/or CD4 cell

percentage < 14%

Preferred:

TMP/SMXb 1 DS PO

daily

or

TMP/SMXb 1 SS PO daily

Alternatives

Dapsonea PO 100 mg/day

Pentamidine 300 mg

inhalation once monthly

TMP/SMX 1 DS PO TIW

Atovaquone PO 1500 mg/

day

Preferred:

TMP/SMXb 15–20 mg/kg PO/IV divided q6–8hr x 21 days

plus

prednisone 40 mg PO q12hr x 5 days; 40 mg/day x 5 days;

20 mg/day x 11 days

(if Pao2 < 70 mm Hg or alveolar-arterial O2 gradient > 35)

(IV methylprednisolone could be administered at 75% of

the corresponding oral prednisone dose)

Alternatives:

Pentamidineb IV 4 mg/kg/day

Clindamycin 600–900 mg PO/IV q6–8hr + primaquinea PO

30 mg/day (base)

Atovaquone 750 mg PO q12hr – mild disease

Toxoplasmosis:

< 100 cells/mm3

and Toxoplasma IgG

positive

Preferred:

TMP/SMX 1 DS PO daily

Alternatives:

Dapsonea PO 50 mg/day +

(pyrimethamine 50 mg

PO + leucovorin 25 mg

PO) once weekly

TMP/SMX 1 DS PO TIW

Preferred:

Pyrimethamineb 200 mg PO x 1; then 50–75 mg/day +

sulfadiazineb 1000–1500 mg PO q6hr + leucovorin PO

10–20 mg/day x 6 wk

Alternatives:

Pyrimethamineb 200 mg PO x 1; then 50–75 mg/day +

clindamycin 600–900 mg PO/IV q8hr + leucovorin PO

10–20 mg/day

Pyrimethamineb 200 mg PO x 1; then 50–75 mg/day +

atovaquone 1500 mg PO BID + leucovorin PO 10–20 mg/

day

Mycobacterium avium

complex:

< 50 cells/mm3

M avium complex:

< 50 cells/mm3

AND not receiving

antiretroviral therapy

(ART), remain

viremic while treated

with ART, or have

no options for a fully

suppressive ART

regimen

Preferred:

Azithromycin 1200 mg

once weekly

or

Clarithromycin 500 mg

q12hr

or

Azithromycin 600 mg

twice weekly

Alternatives:

Rifabutinc 300 mg/day

Preferred:

At least two drugs: Clarithromycin 500 mg PO BID or

azithromycin 600 mg/day

plus ethambutolb PO 15–25 mg/kg/day

Additional agents (consider depending on susceptibility

testing, severe disease, or low CD4+ count)

Rifabutinc PO 300 mg/day

Amikacinb IV 10–15 mg/kg/day

fluoroquinolones (moxifloxacin PO/IV 400 mg/day or

levofloxacinb PO/IV 500 mg/day)