| Pathogen | Preventive regimens | ||||
|---|---|---|---|---|---|
| Indication | First choice | Alternatives | |||
| I. Strongly recommended as standard of care | |||||
| Pneumocystis carinii* | HIV-infected or HIV-indeterminate, infants aged 1 to 12 months; HIV-infected children aged 1 to 5 years with CD4+ count < 500 per mm3 or CD4+ percentage < 15%; HIV-infected children aged 6 to 12 years with CD4+ count < 200 per mm3 or CD4+ percentage < 15% | Trimethoprim-sulfamethoxazole (TMP-SMZ), 150/750 mg/m2/day in 2 divided doses orally three times weekly on consecutive days (AII) Acceptable alternative dosage schedules: (AII)
| Dapsone (children aged ≥ 1 month), 2 mg per kg (max 100 mg) orally every day or 4 mg per kg (max 200 mg) orally every day (CII); aerosolized pentamidine (children aged≥5 yr), 300 mg every month via Respirgard II nebulizer (CIII); atovaquone (children aged 1 to 3 months and > 24 months, 30 mg per kg orally every day; children aged 4 to 24 months, 45 mg per kg orally every day) (CII) | ||
| Mycobacterium tuberculosis† | |||||
| Isoniazid-sensitive | TST reaction, ≥ 5 mm or prior positive TST result without treatment or contact with case of active tuberculosis | Isoniazid, 10 to 15 mg per kg (max 300 mg) orally every day × 9 months (AII) or 20 to 30 mg per kg (max 900 mg) orally twice weekly × 9 months (BIII) | Rifampin, 10 to 20 mg per kg (max 600 mg) orally every day × 4 to 6 months (BIII) | ||
| Isoniazid-resistant | Same as above; high probability of exposure to isoniazid-resistant tuberculosis | Rifampin, 10 to 20 mg per kg (max 600 mg) orally every day × 4 to 6 months (BIII) | Uncertain | ||
| Multidrug-(isoniazid and rifampin) resistant | Same as above; high probability of exposure to multidrug- resistant tuberculosis | Choice of drugs requires consultation with public health authorities | None | ||
| Mycobacterium avium complex† | For children aged ≥ 6 years, CD4+ count < 50 per mm3; aged 2 to 6 years, CD4+ count < 75 per mm3; aged 1 to 2 years, CD4+ count < 500 per mm3; aged < 1 year, CD4+ count < 750 per mm3 | Clarithromycin, 7.5 mg per kg (max 500 mg) orally twice daily (AII), or azithromycin, 20 mg per kg (max 1,200 mg) orally every week (AII) | Azithromycin, 5 mg per kg (max 250 mg) orally every day (AII); children aged ≥ 6 years, rifabutin, 300 mg orally every day (BI) | ||
| Varicella zoster virus§ | Significant exposure to varicella or shingles with no history of chickenpox or shingles | Varicella zoster immune globulin (VZIG), 1 vial (1.25 mL) per 10 kg (max 5 vials) IM, administered ≤96 hours after exposure, ideally within 48 hours (AII) | None | ||
| Vaccine-preventable pathogens ¶ | HIV exposure/infection | Routine immunizations (see Figure 1) | None | ||
| II. Generally recommended | |||||
| Toxoplasma gondii** | IgG antibody to Toxoplasma and severe immunosuppression | TMP-SMZ, 150/750 mg per m2 in 2 divided doses orally every day (BIII) | Dapsone (children aged ≥1 month), 2 mg per kg or 15 mg per m2 (max 25 mg) orally every day plus pyrimethamine, 1 mg per kg orally every day plus leucovorin, 5 mg orally every 3 days (BIII) Atovaquone (children aged 1 to 3 months and > 24 months, 30 mg per kg orally every day; 14 to 24 months, 45 mg per kg orally every day) (CIII) | ||
| Varicella zoster virus¶ | HIV-infected children who are asymptomatic and not immunosuppressed | Varicella zoster vaccine (see vaccine-preventable pathogens section of this table) (BII) | None | ||
| Influenza virus¶ | All patients (annually, before influenza season) | Influenza vaccine (see vaccine- preventable pathogens section of this table) (BIII) | Rimantadine or amantadine (during outbreaks of influenza A); children aged 1 to 9 years, 5 mg per kg in 2 divided doses orally every day; ≥10 years, use adult doses (CIII) | ||
| III. Not recommended for use in most children; indicated for use only in unusual circumstances | |||||
| Invasive bacterial infections†† | Hypogammaglobulinemia (i.e., IgG < 400 mg per dL) | IVIG (400 mg per kg every 2 to 4 weeks) (AI) | None | ||
| Cryptococcus neoformans | Severe immunosuppression | Fluconazole, 3 to 6 mg per kg orally every day (CII) | Itraconazole, 2 to 5 mg per kg orally every 12 to 24 hours (CII) | ||
| Histoplasma capsulatum | Severe immunosuppression, endemic geographic area | Itraconazole, 2 to 5 mg per kg orally every 12 to 24 hours (CIII) | None | ||
| Cytomegalovirus (CMV)§§ | CMV antibody positivity and severe immunosuppression | Oral ganciclovir, 30 mg per kg orally three times daily (CII) | None | ||