Infectious Diseases II
OI/CD4+ Threshold
for Prophylaxis
Prophylaxis Option
Treatment Option
Mycobacterium
tuberculosis: Primary
prophylaxis not
indicated
Latent infection treatment
Preferred:
Isoniazid (INH) PO 300
mg/day + pyridoxine PO
50 mg/day
Alternatives:
INH 900 mg PO twice
weekly + pyridoxine
100 mg PO twice weekly
Active infection treatment
Preferred:
Rifampinc PO/IV 600 mg/day + INH PO 300 mg/day +
pyrazinamideb PO 20โ25 mg/kg/day + ethambutolb PO
15โ25 mg/kg/day
Cryptococcosis:
Primary prophylaxis
not indicated
Secondary
prophylaxis may be
considered < 100
cells/mm3
Secondary prophylaxis:
Fluconazole 200โ400 mg/
day
Preferred:
Induction therapy x 2 wk:
Liposomal amphotericin IV 3-4 mg/kg/day + flucytosineb
PO 25 mg/kg q6hr
Alternatives:
Induction x 2 wk:
25 mg/kg q6hr
fluconazoleb 800 mg PO/IV daily
fluconazoleb 800 mg PO/IV daily
Preferred:
Consolidation therapy x 8 wk
Fluconazoleb PO/IV 400 mg/day
Preferred:
Maintenance therapy ร 1 yr
Fluconazole PO/IV 200 mg/day
Cytomegalovirus:
Primary prophylaxis
not indicated
Secondary
prophylaxis may be
considered
Secondary prophylaxis:
Valganciclovirb PO 900
mg/day
Preferred:
Induction:
Valganciclovirb PO 900 mg BID for 14โ21 days
or
Ganciclovirb 5 mg/kg q12hr for 14โ21 days
Alternatives:
1. Foscarnetb IV 90 mg/kg q12hr or 60 mg/kg q8hr for
14-21 days
2. Cidofovir IV 5 mg/kg/wk for 2 doses (with probenecid 2
g 3 hr before cidofovir; then 1 g 2 hr after cidofovir and
1 g 8 hr after the dose)
aShould not be used in patients with a glucose-6-phosphate dehydrogenase deficiency
bRenal adjustments may be necessary.
cMonitor for interactions with HAART.
BID = twice daily; DS = double strength; hr = hour(s); INH = isoniazid; IV = intravenous(ly); OI = opportunistic infection; PO = orally; SS = single strength; TIW =
thrice weekly; TMP/SMX = trimethoprim/sulfamethoxazole.
Recertification Course. Lenexa, KS: American College of Clinical Pharmacy, 2014:580-621.