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Regimens for Pneumocystis pneumonia prophylaxis in adults and

adolescents

Drug Oral dose* Selected adverse reactions

Preferred regimen

Trimethoprim- 1 DS tablet daily ¶ Fever, rash, neutropenia,

sulfamethoxazole gastrointestinal upset, transaminase
OR
(cotrimoxazole) elevation
1 SS tablet daily Δ

Alternative regimens ◊

Trimethoprim- 1 DS tablet three times per Fever, rash, neutropenia,

sulfamethoxazole week Δ gastrointestinal upset, transaminase
(cotrimoxazole) elevation

OR

Dapsone 50 mg twice daily Fever, rash, gastrointestinal upset,

methemoglobinemia, hemolytic
OR
anemia (check for G6PD deficiency)
100 mg daily

OR

Atovaquone suspension 1500 mg orally once daily Gastrointestinal distress, rash

given with food Δ

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 300 mg monthly (via Cough, wheezing, extrapulmonary

pentamidine Respirgard II nebulizer) pneumocystosis

A regimen that provides prophylaxis for PCP and toxoplasmosis should be administered to HIV-
infected patients who are IgG seropositive for toxoplasmosis AND have a CD4 count <100
cells/microL.

DS: double-strength oral tablet, 160 mg trimethoprim with 800 mg sulfamethoxazole; SS: single-
strength oral tablet, 80 mg trimethoprim with 400 mg sulfamethoxazole; G6PD: glucose-6-
phosphate dehydrogenase; PCP: Pneumocystis pneumonia; HIV: human immunodeficiency virus;
IgG: immunoglobulin G; 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.

Adapted from: Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention
and treatment of opportunistic infections in HIV-infected adults and adolescents: Recommendations from the Centers
for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious
Diseases Society of America. https://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf (Accessed on June 23, 2017).

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