HIV in Children

TREATMENT OF PNEUMOCYSTIS JIROVECI / PNEUMOCYSTIS CARINII (PCP)

Dr. Ira Shah
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Last Updated : 1st September 2012

Drugs

Dosing

Remarks

1) TMP/SMX 15-20 mg/kg of TMP
IV in 4 divided doses for 21 days.
Drug of choice Shift to oral administration as soon as clinical improvement occurs.
2) Pentamidine 4 mg/kg/day OD IV for 21 days or shift to
oral Atovaquone after 7-10 days of IV therapy.
Alternative drug if child intolerant to TMP-SMX or no clinical improvement after 5-7 days of TMP-SMX.
3) Atovaquone 30-40 mg/kg/day PO in BD doses for 21 days (max 750 mg/dose. For children between 3-24 months dose of 45 mg/kg/day Limited data in children
- Alternative therapy.
4) Primaquine / Clindamycin Primaquine base 0.3 mg/kg OD PO (max 30 mg/day)
                        +
Clindamycin 10 mg/kg IV or PO every 6 hours (max: 600 mg IV, 300-450 mg PO) for 21 days.
Alternative therapy
- Data in children not available
5) Dapsone / Trimethoprim Dapsone - 2 mg/kg/day OD PO
                        +
Trimethoprim 15 mg/kg/day in 3 divided doses PO for 21 days.
Limited data in children - Alternative therapy.
6) Steroids Prednisolone
Day 1-5 - 2 mg/kg/ day PO BD
Day 6-10 - 1 mg/kg/day PO
Day 11-12 - 0.5 mg/kg/day PO
                        OR
IV Methyl Prednisolone
Day 1-7 - 1 mg/kg/every 6 hours
Day 8 & 9 - 1 mg/kg every 12 hours Day 10 & 11 - 0.5 mg/kg every 12 hours
Day 12-16 - 1 mg/kg every 24 hours
Indications
- PaO 2 <70 mm of Hg at room air

TREATMENT OF PNEUMOCYSTIS JIROVECI / PNEUMOCYSTIS CARINII (PCP)
Dr. Ira Shah
Incharge Pediatric HIV and TB Clinic, B.J.Wadia Hospital for Children, Mumbai, India Consultant in Pediatric Infectious Diseases, Nanavati Hospital, Mumbai, India.