3.30 MB - Academy of Medicine of Malaysia
3.30 MB - Academy of Medicine of Malaysia
3.30 MB - Academy of Medicine of Malaysia
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Appendix 7<br />
MANAGEMENT OF HIV INFECTION IN CHILDREN<br />
Treatment for opportunistic Infections*<br />
Other options/issues<br />
Alternative therapies<br />
Preferred therapies and duration<br />
Pathogen<br />
Indications for corticosteriods:<br />
- PaO2 35 mm Hg<br />
Continue secondary prophylaxis<br />
Intolerant or clinical treatment<br />
failure after 5-7 days <strong>of</strong><br />
TMP/SMX therapy:<br />
Pentamidine 4 mg/kg body<br />
weight intravenously once daily<br />
Trimethoprim-sulfamethoxazole<br />
(TMP/SMX) 15-20 mg/kg body weight TMP<br />
plus 75-100 mg/kg body weight SMX<br />
administered IV or Oral 3 or 4 times daily<br />
for 21 days<br />
Pneumocystis<br />
jiroveci<br />
pneumonia<br />
Pyridoxine should be administered if isoniazid is<br />
administered<br />
Alternative drug for ethambutol<br />
is streptomycin<br />
Intensive<br />
Mycobacterium<br />
tuberculosis (TB)<br />
In antiretroviral-naïve child, initiate therapy for TB<br />
4-8<br />
weeks before starting antiretroviral drugs<br />
Optimal timing <strong>of</strong> commencement <strong>of</strong> HAART in<br />
newly diagnosed HIV infected children with TB<br />
disease remains unclear. In general, antiretroviral<br />
therapy should be commenced at least 1-2<br />
months after commencement <strong>of</strong> antituberculous<br />
therapy. For children already on HAART when TB<br />
is diagnosed, treatment should be continued however<br />
alteration <strong>of</strong> drug combinations may be<br />
required to minimize potential toxicities and drugdrug<br />
interactions.<br />
Ethionamide should be used<br />
for tuberculosis meningitis<br />
Isoniazid (INH) 10-15 mg/kg(max: 300 mg/day)<br />
oral daily<br />
Rifampicin 10-20 mg/kg body weight<br />
(max:600 mg/day) oral daily<br />
pyrazinamide 20-40 mg/kg<br />
(max: 2 g/day) body weight oral daily<br />
ethambutol 15-25 mg/kg body weight<br />
(max: 1.0 g/day) oral daily<br />
83<br />
Treatment duration<br />
Pulmonary TB: 9 months for HIV infected child<br />
Continuation phase (for drug sensitive TB):<br />
Daily:<br />
Isoniazid 10-15 mg/kg body weight<br />
(max: 300 mg/day) oral daily plus<br />
rifampicin 10-20 mg/kg body weight<br />
(max: 600 mg/ day) oral daily<br />
OR<br />
Intermittent:<br />
Isoniazid 20-30 mg/kg body weight (max:<br />
900 mg/day) by mouth once daily<br />
administered two to three times a week plus<br />
rifampicin 10-20 mg/kg body weight (max:<br />
600 mg/day) by mouth once daily<br />
administered two to three times a week
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