Back to Table of
Contents
University of Pennsylvania Medical Center Guidelines for Antibiotic Use
| Infection | Recommended Therapy | Dosage Regimen | Duration |
|
Pneumocystis carinii Pneumonia Treatment |
2nd Choice mild/moderate dapsone3 + trimethoprim OR clindamycin + primaquine3 OR atovaquone4 severe2 pentamidine |
TMP/SMX 15-20mg/kg/d TMP IV/PO in 3-4 divided doses dapsone3 100mg PO q day trimethoprim 20mg/kg/d PO in 3-4 divided doses clindamycin 600mg IV q 6 hour OR 300-450mg PO QID primaquine3 15mg base PO q day atovaquone 750mg PO BID4 pentamidine 4mg/kg/d IV |
21 days |
|
Prophylaxis (secondary PCP, CD4 < 200/mm3 or < 20%) |
1st Choice TMP/SMX 2nd Choice dapsone3 3rd Choice pentamidine |
TMP/SMX 160/800mg (1 DS tablet) PO 3 times/week5 dapsone 50-100mg PO q day6 pentamidine 300mg q month (aerosolized) |
Chronic |
|
Toxoplasmosis Treatment |
2nd Choice pyrimethamine + clindamycin |
pyrimethamine7 200mg PO x 1 then 75mg PO q day sulfadiazine 1-1.5 gm PO QID clindamycin 600mg IV/PO QID |
6 weeks |
| Chronic Suppressive Therapy |
1st Choice pyrimethamine + sulfadiazine 2nd Choice pyrimethamine + clindamycin |
pyrimethamine7 25mg PO q day sulfadiazine 500mg PO QID clindamycin 300mg PO QID |
Chronic |
|
Prophylaxis (IgG antibody to Toxoplasma and CD4 count < 100/mcl) |
TMP/SMX | TMP/SMX 160/800mg (1 DS tablet) PO q day | Chronic |
1Consultation with experienced HIV practitioner recommended
2Add steroids if PO2 áDþÿ4 70mm Hg on room air
(prednisone 40mg bid x 5 day, then 40mg q day x 5 day then, 20mg q day x 11 day)
3Assay for G-6-PD deficiency recommended before therapy
4Atovoquone must be taken with food (preferrably fatty) for adequate absorption
53x/week = Monday, Wednesday, Friday
6If dapsone 50mg PO q day regimen: add pyrimethamine 50mg PO q week and folinic acid 25mg PO q week
7With folinic acid 10-20mg q day
| Infection | Recommended Therapy | Dosage Regimen | Duration |
|
Candidiasis Oral1 |
1st choice clotrimazole troche 2nd choice fluconazole OR amphotericin B oral suspension |
clotrimazole troche 10mg 5x/day fluconazole 50-100mg PO q day amphotericin B oral suspension - 100mg swish, hold then swallow QID |
As needed |
| Esophageal1 |
1st choice fluconazole 2nd choice amphotericin B |
fluconazole 100-200mg PO q day amphotericin B 0.3mg/kg IV q day (Table VII) |
2-3 weeks 7 days |
| Vaginal |
clotrimazole (if refractory, fluconazole) |
clotrimazole 100mg intravaginally q day fluconazole 100mg PO q day |
7 days2 |
| Cryptococcosis |
amphotericin B + flucytosine then fluconazole |
amphotericin B 0.7mg/kg/d IV (TableVII) PLUS flucytosine 100mg/kg/d PO in 4 divided doses THEN: fluconazole 400mg PO q day x 10 weeks, then fluconazole 200mg PO q day for suppressive therapy |
amphotericin B + flucytosine 14 days then fluconazole as noted in dosage regimen section |
1Primary and secondary prophylaxis controversial
2May require
continuous therapy to prevent relapse
| Infection | Recommendation | Dosage Regimen | Duration |
|
Tuberculosis, Treatment - Pulmonary or Extrapulmonary1 |
isoniazid and | 300mg PO q day | Controversial - discuss with Infectious Diseases consult service |
| rifampin and | 600mg PO q day | ||
| pyrazinamide and | 25mg/kg/d PO q day | ||
| ethambutol | 15-25mg/kg/d PO | ||
| ± levofloxacin | 750-1000mg PO q day | ||
| ± streptomycin | 15mg/kg IM q day | ||
| Prophylaxis - Primary and Secondary2 | isoniazid3 | 300mg PO q day | Controversial - discuss with Infectious Diseases consult service |
|
Disseminated Mycobacterium avium Complex Treatment |
clarithromycin OR | 500mg PO BID | Chronic |
| azithromycin PLUS | 500mg PO q day | ||
| ethambutol THEN | 15mg/kg/d PO | ||
| consider adding 1 or 2 of the following if symptoms persist or if patient acutely ill | |||
| rifabutin | 300mg PO q day | ||
| ciprofloxacin | 500-750mg PO BID | ||
| amikacin |
15mg/kg/d IM/IV x 7-14 days then 7.5mg/kg/d IM 3x/week |
||
| Prophylaxis |
azithromycin OR clarithromycin |
1200mg PO q week 500mg PO BID |
Chronic |
1If patient has a history of noncompliance or has previously received therapy, discuss with an Infectious Diseases Practitioner
2Some evidence
suggests that prophylaxis of all patients in high prevalence areas
may be advisable regardless of PPD status
3Patients receiving isoniazid
should receive pyridoxine 50mg po q day
| Infection | Recommendation | Dosage Regimen | Duration |
|
Cytomegalovirus (retinitis, colitis, esophagitis) Treatment |
ganciclovir | 5 mg/kg IV q 12 hour | 14 - 21 days |
| foscarnet1 (if refractory) | 60 mg/kg IV q 8 hour1 | ||
| cidofovir2 | 5 mg/kg IV q week | x 2 doses | |
| Chronic Suppressive (retinitis) | ganciclovir |
5 mg/kg IV q day OR 1 gm PO tid3 |
Chronic |
| foscarnet1 (if refractory) | 90-120 mg/kg/d IV1 | ||
| cidofovir2 | 5 mg/kg IV q 2 weeks | ||
|
Syphilis4 Primary, Secondary, Latent < 1 year Latent > 1 year, Indeterminate origin or Cardiovascular Neurosyphilis |
benzathine penicillin |
2.4mu IM q week |
x 3 weeks |
|
Herpes Simplex Virus5 Treatment Stomatitis/genital Perirectal |
valacyclovir |
1 gm PO BID |
5 days |
|
Chronic Suppressive (if recurrence is frequent or severe) |
valacyclovir | 500mg PO q day | Chronic |
1Premedicate before each dose with 500-1000ml sodium chloride 0.9% (decreases the incidence of nephrotoxicity)
2Because of toxicity and difficulty of administration, cidofovir may be used only in consultation with Infectious Diseases
3Should be administered with a fatty meal; oral ganciclovir IS NOT for sight-threatening disease
4Recommendations vary, most use standard regimen
5Resistant cases may require foscarnet