Version May 2024
| Drug | Oral dose* | Selected adverse reactions |
| Preferred regimen | ||
| Trimethoprim-sulfamethoxazole (cotrimoxazole) | 1 DS tablet daily¶ OR 1 SS tablet dailyΔ | Fever, rash, neutropenia, gastrointestinal upset, transaminase elevation |
| Alternative regimens◊ | ||
| Trimethoprim-sulfamethoxazole (cotrimoxazole) | 1 DS tablet three times per weekΔ | Fever, rash, neutropenia, gastrointestinal upset, transaminase elevation |
| OR | ||
| Dapsone | 50 mg twice daily OR 100 mg daily | Fever, rash, gastrointestinal upset, methemoglobinemia, hemolytic anemia (check for G6PD deficiency) |
| OR | ||
| Atovaquone suspension | 1500 mg orally once daily given with foodΔ | Gastrointestinal distress, rash |
| OR | ||
| Combination of:Δ | ||
| Dapsone | 50 mg daily plus | Fever, rash, gastrointestinal upset, methemoglobinemia, hemolytic anemia (check for G6PD deficiency) |
| Pyrimethamine | 50 mg weekly plus | Folate deficiency, gastrointestinal upset, rash |
| Leucovorin | 25 mg weekly | Rash, thrombocytosis, wheezing, anaphylactoid reactions |
| OR | ||
| Combination of:Δ | ||
| Dapsone | 200 mg weekly plus | Fever, rash, gastrointestinal upset, methemoglobinemia, hemolytic anemia (check for G6PD deficiency) |
| Pyrimethamine | 75 mg weekly plus | Folate deficiency, gastrointestinal upset, rash |
| Leucovorin | 25 mg weekly | Rash, thrombocytosis, wheezing, anaphylactoid reactions |
| OR | ||
| Aerosolized pentamidine | 300 mg monthly (via Respirgard II nebulizer) | Cough, wheezing, extrapulmonary pneumocystosis |
DS: double-strength oral tablet, 160 mg trimethoprim with 800 mg sulfamethoxazole; G6PD: glucose-6-phosphate dehydrogenase; HIV: human immunodeficiency virus; IgG: immunoglobulin G; PCP: Pneumocystis pneumonia; SS: single-strength oral tablet, 80 mg trimethoprim with 400 mg sulfamethoxazole; TMP-SMX: trimethoprim-sulfamethoxazole.
* The doses recommended in the table are intended for patients with normal renal function; the doses of some of these agents must be adjusted in patients with renal insufficiency.
¶ This regimen is also the preferred regimen for prevention of toxoplasmosis.
Δ This regimen is considered an alternative regimen for prevention of toxoplasmosis.
◊ Of the alternative regimens for prevention of PCP, TMP-SMX three times weekly is generally preferred. If patients cannot tolerate TMP-SMX, we prefer to use dapsone (or dapsone with pyrimethamine and leucovorin for patients who require prophylaxis for toxoplasmosis) rather than atovaquone. Dapsone is a sulfone that is usually tolerated by persons who have adverse reactions to TMP-SMX. However, in patients who have had serious reactions to TMP-SMX (eg, Stevens-Johnson syndrome/toxic epidermal necrolysis, rash with fever and systemic symptoms, serum sickness, or hemolytic anemia), it may be prudent to avoid dapsone. Aerosolized pentamidine should be used for PCP prophylaxis only when no other alternatives are available.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
