The following are recommended as standard of care.1, 2
Preferred Treatment
Alternative Treatment
Pneumocystis carinii
Trimethoprim (TMP) 15 mg/kg/day + sulfamethoxazole (SMX)75 mg/kg/day PO or IV x 21 days in 3-4 divided doses (typical oral dosage is 2 DS tid)
TMP15 mg/kg/day PO + dapsone 100 mg/day PO x 21 days
Pentamidine 4 mg/kg/day IV x 21 days (often reserved for severe cases)
Clindamycin 600 mg IV q8h or 300-450 mg PO q6h + primaquine 30 mg/day base PO x 21 days
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Atovaquone 750 mg suspension PO with meal bid x 21 days
Trimetrexate 45 mg/m² /day + folinic acid 20 mg/m² or IV q6h
Toxoplasma gondii
Pyrimethamine 100-200 mg loading dose; then 50-100 mg/day PO + folinic acid 10 mg/day PO + sulfadiazine or trisulfapyrimidime 4-8 g/day PO for at least 6 weeks
Pyrimethamine + folinic acid (see preferred regimen) + clindamycin 900-1,200** mg IV q6h or 300-450 mg PO q6h for at least 6 weeks
Pyrimethamine and folinic acid (see preferred regimen) plus one of the following: azithromycin 1,200-1,500 mg/day, clarithromycin 1 g bid, or atovaquone 750 mg qid with food
Azithromycin + 900 mg PO x 2 first day, then 1,200 mg/day x 6 weeks, then 600 mg/day (patients <50 kg receive half dose) (salvage therapy)
Mycobacterium avium complex (MAC)
Clarithromycin 500 mg PO bid plus Ethambutol (EMB) 15 mg/kg/day PO
Azithromycin 600 mg/day PO in place of clarithrmycin + Ethambutol (EMB) + Rifabutin (RFB) (same doses)
Combination treatment with amikacin 10-15 mg/kg/day IV or ciprofloxacin 500-700 mg bid
Varicella zoster
Dermatomal: Acyclovir 800 mg PO 5x/day at least 7 days (until lesions crust) or famciclovir 500 mg PO tid or valacyclovir 1 g PO tid x >7 days
Disseminated, opthalmic nerve involvement or visceral: Acyclovir 30-36 mg/kg/day IV at least 7 days
Acyclovir-resistant strains: Foscarnet 40 mg/kg IV q8h or 60 mg/kg q12h
Dermatomal: Acyclovir 30 mg/kg/day IV
Foscarnet 40 mg/kg IV q8h or 60 mg/kg IV q12h
Disseminated, opthalmic nerve involvement or visceral: Foscarnet 40 mg/kg IV q8h or 60 mg/kg IV q12h
Foscarnet 60 mg/kg IV q8h or 90 mg/kg IV q12h x 14 to 21 days
Ganciclovir 5 mg/kg IV bid x 14 to 21 days
Valganciclovir 900 mg PO bid x 21 days, then 900 mg/day
Cidofovir 5 mg/kg IV q week x2, then 5 mg/kg q 2 weeks + probenecid, 2 g PO 3 hours before each dose, 1 g PO at 2 and 8 hours post dose (total of 4 g)
Alternating or combining foscarnet and ganciclovir
Intraocular injections of foscarnet 1.2-2.4 mg in 0.1 mL (N Engl J Med 1994;330:868) or ganciclovir 2,000 µg in 0.05-0.1 mL (Br J Ophthal 1996;80:214)
Fomivirsen, 330 mg by intravitreal injection day 1 and 15, then monthly
Herpes Simplex
Mild: Acyclovir 400 mg PO tid or famciclovir 250 mg PO tid or valacyclovir 1.0 g PO bid; all given for 7 to 10 days
Severe or Refractory: 1. Acyclovir up to 800 mg PO 5x/day or 15-30 mg/kg/day IV at least 7 days
2. Valacyclovir 1 g PO bid-tid
Severe or Refractory: Foscarnet 40 mg/kg IV q8h or 60 mg/kg q12h x 3 weeks
Topical trifluridine as 1% ophthalmic solution q8h
Alternative topical agents: Cidofovir 3% and foscarnet 1% cream
Cidofovir 5 mg/kg q 2 weeks (limited experience)
** Initital Treatment Recommendations of the IAS-USA (Arch Intern Med 1998;158:957). For information on maintenance and other forms of therapy, consult reference below.
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