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 20–25 mg/kg/day + ethambutolb PO

15–25 mg/kg/day

Cryptococcosis:

Primary prophylaxis

not indicated

Secondary

prophylaxis may be

considered < 100

cells/mm3

Secondary prophylaxis:

Fluconazole 200–400 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 × 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 14–21 days

or

Ganciclovirb 5 mg/kg q12hr for 14–21 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.