Page 103 - HPP ANTIMICROBIAL GUIDELINE 2018

Suggested Treatment
Infection/ Condition Comments
Preferred Alternative

Histoplasmosis & Penicilliosis

Mild (Outpatient) Itraconazole 200mg PO q8h for Itraconazole oral suspension is
3 days (loading) then preferred over capsule because of
200mg PO q12h for 12 weeks improved bioavailability.

Moderate- to-severe disseminated Conventional amphotericin B ƚ Voriconazole 6mg/kg PO/IV q12h for Beware of drug-drug interaction with
disease 0.7mg/kg IV q24h for at least 2 weeks then 4mg/kg PO/IV q12h for ARV. (Voriconazole is
Induction therapy 2 weeks or clinical improvement 10 days contraindicated with Efavirenz)

Maintenance therapy Itraconazole 200mg OD until ƚ The lipid formulations of
(moderate to severe) immunity is restored. amphotericin B (3-5mg/kg/day) may
be used instead if available

Nocardia infection Trimethoprim (TMP)/ Imipenem/cilastatin 500mg IV q6h Duration of oral regimen is to be
Initial Therapy sulfamethoxazole (80/400mg) TMP continued until immunity is restored
15mg/kg/q24h IV/PO in 3 divided PLUS

doses Amikacin 7.5mg/kg IV q12h for 2-4
weeks or clinical improvement
May consider decreasing to followed by oral regimen
Trimethoprim (TMP)/
sulfamethoxazole (80/400mg)
10mg/kg/24h after IV/PO clinical
improvement

References:
1. 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.
(Accessed on August 08, 2017).
2. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America.
3. The World Health Organization. Guidelines for the diagnosis, prevention and management of cryptococcal disease in HIV-infected adults, adolescents,
and children. March 2018.
4. Workowski KA, Berman S. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep 2010; 59(RR-12):23

HPP AMG Human Immunodeficiency Virus 46