Page 902 - Hall et al (2015) Principles of Critical Care-McGraw-Hill

CHAPTER 69: Human Immunodeficiency Virus (HIV) and AIDS in the Intensive Care Unit 633

TABLE 69-4 Antimicrobial Therapy of Common Infections in AIDS Patients (Continued)
Infection Drug of Choice Total Daily Dose Dose Interval Route Usual Duration Alternative Therapy
Pneumocystosis Intravenous therapy
(P jirovecii) TMP-SMX TMP 15-20 mg/kg and SMX 6-8 h IV 21 d Clindamycin 600 mg q6h IV plus
75-100 mg/kg primaquine 30 mg (base) daily PO
or
Pentamidine 4 mg/kg per day IV
Oral therapy
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TMP-SMX TMP 15-20 mg/kg and SMX 8 h PO 21 d TMP-SMX 2 DS tablets q8h PO;
75-100 mg/kg
or dapsone 100 mg daily plus TMP
5 mg/kg PO TID
or clindamycin 450 mg q6h PO plus
primaquine 30 mg (base) daily
or atovaquone 750 mg q12h PO with
food
Primary Prophylaxis or Maintenance
therapy:
TMP-SMX 1 DS tablet (preferred) Daily PO Indefinitely Dapsone 100 mg PO daily,
Or 1 SS tablet Or atovaquone 1500 mg PO daily
Candidiasis Fluconazole 100 mg Daily PO 7-14 d Itraconazole 100 mg PO daily for 14 d e
oropharyngeal (or 100 mg BID for 7 d); or
topical antifungal (nystatin or
clotrimazole 3-5 times daily)
Esophageal Fluconazole 100-400 mg Daily PO/IV 14-21 d Itraconazole 200 mg PO daily
(3 weeks) e
or Voriconazole 200 mg PO/IV BID,
or Posaconazole 400 mg PO BID,
or an echinocandin,
or amphotericin B formulation
Fluconazole refrac- Itraconazole oral solution e 200-400 mg 12 h PO 2 weeks An echinocandin IV
tory mucosal (swish
candidiasis (oral and
esophageal) swal-
low)
or an amphotericin B formulation IV,
or Voriconazole PO/IV,
or posaconazole PO/IV
Cryptococcal men- Liposomal amphotericin B 3-4 mg/kg Daily IV ≥2 weeks amphotericin B 0.7 mg/kg/d IV
ingitis (Cryptococcus plus 5-flucytosine; or fluconazole
neoformans) 800 mg/d, plus 5-flucytosine
Plus
5-Flucytosine 100 mg/kg 6 h PO ≥2 weeks
Then consolidation:
Fluconazole 400 mg Daily PO/IV 8 weeks Itraconazole 200 mg bid PO e
Maintenance therapy:
Fluconazole 200 mg Daily PO ≥12 months
Viral infections
CMV (cytomega- Ganciclovir 10 mg/kg 12 h IV 21 d Foscarnet 90-100 mg/kg IV q12 h
d
lovirus peripheral (infusion over 2 h by pump). For
retinitis, esophagitis, non-ICU patients with CMV retinitis;
colitis, or pneumonia) valganciclovir 900 mg PO BID for 21 d.
For sight-threatening retinitis add
intravitreal ganciclovir or foscarnet
(Continued)

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