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Invasive disease
Amphotericin B lipid formulations can be used for
children who cannot tolerate amphotericin B, have
disseminated Candida infection that is resistance to
amphotericin B, or are at risk of nephrotoxicity
Flucytosine toxicity
Bone marrow: anemia, leukopenia,
thrombocytopenia
Liver, GI, and renal toxicity
Fluconazole toxicity
Potential interaction with ARV should be
evaluated before initiating treatment (A III)
Adverse reactions:
Rash
Stevens-Johnson syndrome (rare)
Neutropenia, thrombocytopenia,
megaloblastic or aplastic anemia
Pentamidine isethionate
Recommended for patients with intolerance
to TMP-SMX or clinical failure with TMP-SMX
(A I); do not combine use
4 mg/kg/day IV once daily over period of 60-
90 minutes
Consider oral atovaquone after 7-10 days
(B III)
Clindamycin/primaquine
Used for mild to moderate PCP in adults;
no data in children (C III)
Primaquine contraindicated in G6PD
deficiency
Clindamycin/primaquine
Pediatric clindamycin dosing based on other
uses: 20-40 mg/kg/day IV divided into 3 or 4
doses, administered for 21 days
Primaquine dosing based on malaria: 0.3
mg/kg daily of the base, administered orally
for 21 days
Adverse reactions include rash, nausea,
diarrhea, pseudomembranous colitis
Corticosteroids
Consider use in moderate to severe
PCP
Use within 72 hours of diagnosis
Results in reduced respiratory failure,
decreased ventilation requirements,
and decreased mortality
Corticosteroids
Dosing recommendations vary
Prednisone: 40 mg BID for 1-5 days; 40
mg once daily days 6-10; 20 mg once
daily days 11-21
Alternative: prednisone 1 mg/kg BID days
1-5; 0.5 mg/kg BID days 6-10; 0.5 mg/kg
once daily days 11-21