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::::* Recurrent bacteremia: 2–6 weeks.
::::* Recurrent bacteremia: 2–6 weeks.


:* 6:28 Shigellosis
::* Treatment
:::* Preferred regimen: Ciprofloxacin 500–750 mg PO (or 400 mg IV) q12h
:::* Duration of Therapy:


::::* Gastroenteritis: 7–10 days • Bacteremia: ≥14 days • Recurrent Infections: 2–6 weeks
:::* Alternate regimen: Levofloxacin 750 mg (PO or IV) q24h {{or}}  Moxifloxacin 400 mg (PO or IV) q24h  {{or}}  TMP 160 mg-SMX 800 mg (PO or IV) q12h {{or}} Azithromycin 500 mg PO daily for 5 days.
:::* Note
::::* Antimotility agents should be avoided




Revision as of 02:52, 13 July 2015

  • HIV/AIDS
  • 1.Antiretroviral Regimen Options for Treatment-Naive Patients[1]
  • 1.1 A Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI) Based Regimen:
  • 1.2 Integrase Strand Transfer Inhibitor-Based Regimens
  • Preferred regimen:
  • Alternative Regimen
  • 1.3 Protease Inhibitor-Based Regimen
  • Alternative Regimen(2)
  • Alternative Regimen(3)
  • Alternative Regimen(4)
  • Alternate Regimen(5)
  • Atazanavir 300 mg-Ritonavir 100 mg once-daily AND Abacavir 600 mg-Lamivudine 300 mg once-daily in patients who are HLA-B*5701-negative and with pre-treatment HIV RNA <100,000 copies/mL.
  • Alternate Regimen(6)
  • Alternate Regimen(7)
  • 1.4 Other Regimen Options
  • 1.4.1 NNRTI-Based Regimen
  • Preferred regimen: Efavirenz 600mg AND Abacavir 600 mg/Lamivudine—only for patients who are HLA-B*5701 negative and with pre-treatment HIV RNA <100,000 copies/mL.
  • 1.4.2 Other Regimens When Tenofovir or Abacavir Cannot be Used
Pediatric dose: Abacavir 300 mg po BID, Didanosine 20 to < 25 kg: 200 mg po once daily 25 to < 60 kg: 250 mg po once daily ≥60 kg: 400 mg po once daily; Lamivudine 4 mg/kg/dose po BID; maximum 150 mg po BID; Stavudine 1 mg/kg/dose po q12h, Tenofovir Recommended oral dose is 8 mg/kg; Zidovudine 180 - 240 mg/m2/dose po q12h or 160 mg/m2/dose po q8h (range 90-180); Efavirenz 10 to < 15 kg: 200 mg, 15 to <20 kg: 250 mg, 20 to < 25 kg: 300 mg, 25 to < 32.5 kg: 350 mg, 32.5 to <40 kg: 400 mg, ≥ 40 kg: 600 mg; Nevirapine maximum 200 mg per dose; Lopinavir 400mg; Nelfinavir 50 mg/kg/dose po BID; Raltegravir 300mg
  • 2. Pre-Exposure Prophylaxis(PrEP)
  • Preferred regimen- Daily, continuing, oral doses of Tenofovir disoproxil fumarate 300mg-Emtricitabine 200 mg, ≤90-day supply.
Note(1): People with high risk behaviour such as men who have sex with men, intravenous drug abusers, HIV-positive sexual partner, recent bacterial STI, high number of sex partners, history of inconsistent or no condom use, commercial sex work, people in high-prevalence area or network are advised to take pre-exposure prophylaxis of drugs.
Note(2): Follow-up visits at least every 3 months to provide the following: HIV test, medication adherence counseling, behavioral risk reduction support, side effect assessment, STI symptom assessment, pregnancy testing.
Note(3): At 3 months and every 6 months thereafter, assess renal function.
Note(4): Every 6 months, test for bacterial STIs.
  • 3. Post- Exposure Prophylaxis
  • 4. Perinatal Antiretroviral Regimen
  • 4.1 Antepartum
  • 4.1.1 Protease Inhibitor-Based Regimen
  • 4.1.2 A non-nucleoside reverse transcriptase inhibitor (NNRTI) based regimen:
  • 4.2 Intrapartum
  • HIV RNA <1000 copies/mL and good afherance-Continue the regimen during delivery or cessarean section.
  • HIV RNA >1000 copies/mL near delivery, possible poor adherence, or unknown HIV RNA levels- Intravenous Zidovudine 2 mg/kg IV over 1 hr should be given three hours before cesarean section or delivery and then 1 mg/kg/hr IV continuous infusion until umbilical cord clamping.
  • 4.3 Postpartum
Initiate ART and continue after delivery and cessation of breastfeeding
  • 5.Infant Antiretroviral Prophylaxis for Prevention of Mother-To-Child Transmission of HIV
  • 5.1 Preferred regimen: Zidovudine (ZDV) 100mg given at birth and continued till six weeks.
Note(1): Dose based on gestational age at birth and weight, initiated as soon after birth as possible and preferably within 6 to 12 hours of delivery.
Note(2): ≥35 weeks gestation at birth: 4 mg/kg/dose orally (or, if unable to tolerate oral agents, 3 mg/kg/dose IV) every 12 hours.
Note(3): ≥30 to <35 weeks gestation at birth: 2 mg/kg/dose orally (or 1.5 mg/kg/dose IV) every 12 hours, advanced to 3 mg/kg/dose orally (or 2.3 mg/kg/dose IV) every 12 hours at age 15 days.
  • <30 weeks gestation at birth: 2 mg/kg/dose orally (or 1.5 mg/kg/dose IV) every 12 hours, advanced to 3 mg/kg/dose orally (or 2.3 mg/kg/dose IV) every 12 hours after age four weeks.
  • 5.2 Prophylaxis for HIV-exposed infants of women who received no antepartum antiretroviral prophylaxis
  • Dose based on birth weight, initiated as soon after birth as possible.
  • Birth weight 1.5 to 2 kg: 8 mg/dose orally.
  • Birth weight >2 kg: 12 mg/dose orally.
AND
Zidovudine (ZDV)
  • Dose based on gestational age at birth and weight, initiated as soon after birth as possible and preferably within 6 to 12 hours of delivery.
  • ≥35 weeks gestation at birth: 4 mg/kg/dose orally (or, if unable to tolerate oral agents, 3 mg/kg/dose IV) every 12 hours.
  • ≥30 to <35 weeks gestation at birth: 2 mg/kg/dose orally (or 1.5 mg/kg/dose IV) every 12 hours, advanced to 3 mg/kg/dose orally (or 2.3 mg/kg/dose IV) every 12 hours at age 15 days.
  • <30 weeks gestation at birth: 2 mg/kg/dose orally (or 1.5 mg/kg/dose IV) every 12 hours, advanced to 3 mg/kg/dose orally (or 2.3 mg/kg/dose IV) every 12 hours after age four weeks.
Note(1): Three doses in the first week of life
Note(2): First dose within 48 hours of birth (birth to 48 hrs)
Note(3): Second dose 48 hours after first
Note(4): Third dose 96 hours after second
  • 6 Treatment and Prevention of Opportunistic Infections
  • 6.1 Pneumocystis pneumonia (PCP)
  • 6.1.1 Prevention
  • 6.1.1.1 Indication:
  • CD4 count <200 cells/mm3
  • Oropharyngeal candidiasis
  • CD4 <14%
  • History of AIDS-defining illness
  • CD4 count >200 but <250 cells/mm3 if monitoring CD4 cell count every 3 months is not possible.
  • 6.1.2 Treatment
  • Preferred regimen:
  • For Moderate-to-Severe PCP TMP-SMX 15–20 mg AND SMX 75–100 mg]/kg/day IV given q6h or q8h, may switch to PO after clinical improvement.
  • For Mild-to-Moderate PCP TMP 15–20 mg AND SMX 75–100 mg]/kg/day, given PO in 3 divided doses OR TMP-SMX: 160 mg/800 mg or DS) 2 tablets PO TID.
  • Secondary Prophylaxis, after completion of PCP treatment TMP-SMX DS: 1 tablet PO daily OR TMP-SMX (80 mg/400 mg or SS): 1 tablet PO daily.
  • Alternative regimen:
  • For Moderate-to-Severe PCP Pentamidine 4 mg/kg IV daily infused over ≥60 minutes; can reduce dose to 3 mg/kg IV daily because of toxicities OR Primaquine 30 mg (base) PO daily AND clindamycin 600 mg q6h IV OR 900 mg IV q8h OR clindamycin 450 mg PO q6h or 600 mg PO q8h.
  • For Mild-to-Moderate PCPDapsone 100 mg PO daily + TMP 5 mg/kg PO TID OR Primaquine 30 mg (base) PO daily + clindamycin 450 mg PO q6h or 600 mg PO q8h) OR Atovaquone 750 mg PO BID with food.
  • 6.1.3 Secondary Prophylaxis, after completion of PCP treatment
  • Alternate regimen(1): TMP-SMX DS: 1 tablet PO three times weekly.
  • Alternate regimen(2): Dapsone 100 mg PO daily.
  • Alternate regimen(5): Dapsone 100 mg PO daily.
  • Alternate regimen(9): Atovaquone 1500 mg PO daily.
  • 6.1.4 Adjunctive Corticosteroids
  • Indications- PaO2 <70 mmHg at room air OR Alveolar-arterial O2 gradient >35 mmHg.
  • Preferred regimen:
  • Days 1–5: 40 mg PO BID
  • Days 6–10: 40 mg PO daily
  • Days 11–21: 20 mg PO daily
  • Note
TMP-SMX should be permanently discontinued in patients with possible or definite StevensJohnson Syndrome or toxic epidermal necrosis.
Whenever possible, patients should be tested for G6PD before use of dapsone or primaquine. Alternative therapy should be used in patients found to have G6PD deficiency.
  • 6.2 Toxoplasma gondii encephalitis
  • 6.2.1 Prevention
  • 6.2.1.1 Indication:
  • Toxoplasma IgG-positive patients with CD4 count <100 cells/µL.
  • Seronegative patients receiving PCP prophylaxis not active against toxoplasmosis should have toxoplasma serology retested if CD4 count decline to <100 cellsµL.
  • Prophylaxis should be initiated if seroconversion occurred.
  • 6.2.2 Treatment
  • Treatment of Acute Infection
  • Preferred regimen: At least 6 weeks (BII); longer duration if clinical or radiologic disease is extensive or response is incomplete at 6 weeks
  • Pyrimethamine 200 mg PO 1 time, followed by weight-based therapy:
  • Chronic Maintenance Therapy:
  • Preferred regimen: Pyrimethamine 25–50 mg PO daily AND Sulfadiazine 2000–4000 mg PO daily (in 2–4 divided doses) AND Leucovorin 10–25 mg PO daily.
  • Alternative Therapy(1): Clindamycin 600 mg PO q8h + (pyrimethamine 25–50 mg + leucovorin 10–25 mg) PO daily.
  • Alternative Therapy(2): TMP-SMX DS 1 tablet BID.
  • Alternative Therapy(3): Atovaquone 750–1500 mg PO BID AND (pyrimethamine 25 mg + leucovorin 10 mg) PO daily.
  • Alternative Therapy(4): Atovaquone 750–1500 mg PO BID + Sulfadiazine 2000–4000 mg PO daily (in 2–4 divided doses.
  • Alternative Therapy(5): Atovaquone 750–1500 mg PO BID with food.
  • 6.3Mycobacterium tuberculosis infection
  • 6.3.1 Prevention
  • 6.3.1.1 Indication:
  • (+) screening test for LTBIc , with no evidence of active TB, and no prior treatment for active TB or LTBI.
  • Close contact with a person with infectious TB, with no evidence of active TB, regardless of screening test results.
  • Preferred regimen: INH 300 mg + Pyridoxine 25 mg) PO daily x 9 months OR INH 900 mg PO BIW (by DOT) + Pyridoxine 25 mg PO daily x 9 months.
  • Alternative Therapy(1): Rifampin 600 mg PO daily x 4 months.
  • Alternative Therapy(2): Rifabutin (dose adjusted based on concomitant ART)d x 4 months.
  • 6.3.1.2 Treatment:
  • Preferred regimen: Initial Phase (2 Months, Given Daily, 5–7 Times/Week by DOT)
INH + [RIF or RFB] + PZA + EMB
  • Continuation Phase
INH + (RIF or RFB) daily (5–7 times/week) or TIW
  • Total Duration of Therapy (For Drug-Susceptible TB)
Note:
  • Pulmonary TB: 6 months (BII) • Pulmonary TB and culturepositive after 2 months of TB treatment: 9 months (BII) • Extra-pulmonary TB w/CNS infection: 9–12 months (BII); • :::* Extra-pulmonary TB w/bone or joint involvement: 6 to 9 months (BII); • Extra-pulmonary TB in other sites: 6 months (BII) Total duration of therapy should be based on number of doses received, not on calendar time.
  • Treatment for Drug-Resistant TB
  • Resistant to INH: • (RIF or RFB) + EMB + PZA + (moxifloxacin or levofloxacin) for 2 months (BII); followed by (RIF or RFB) + EMB + (moxifloxacin or levofloxacin) for 7 months (BII) Resistant to Rifamycins +/- Other Drugs: • Regimen and duration of treatment should be individualized based on resistance pattern, clinical and microbiological responses, and in close consultation with experienced specialists.
  • 6.3Disseminated Mycobacterium avium complex (MAC) disease
  • Prevention
  • Indication-CD4 count <50 cells/µL—after ruling out active disseminated MAC disease based on clinical assessment.
  • Preferred regimen:
  • Azithromycin 1200 mg PO once weekly (AI), or • Clarithromycin 500 mg PO BID (AI), or • Azithromycin 600 mg PO twice weekly.
  • Treatment
  • 6.5 Streptococcus pneumoniae infection
  • Indication
  • For individuals who have not received any pneumococcal vaccine, regardless of CD4 count, followed by PCV13 0.5 mL IM x 1
  • if CD4 count ≥200 cells/µL PPV23 0.5 mL IM or SQ at least 8 weeks after the PCV13 vaccine
  • if CD4 count <200 cells/µL PPV23 can be offered at least 8 weeks after receiving PCV13 (CIII) or can wait until CD4 count increased to ≥200 cells/µL.
  • For individuals who have previously received PPV23
  • ALternative PPV23 0.5 mL IM or SQ x 1 One dose of PCV13 should be given at least 1 year after the last receipt of PPV23
  • Re-vaccination
  • If age 19–64 years and ≥5 years since the first PPV23 dose PPV23 0.5 mL IM or SQ x 1
  • If age ≥65 years, and if ≥5 years since the previous PPV23 dose PPV23 0.5 mL IM or SQ x 1.
  • If age ≥65 years, and if ≥5 years since the previous PPV23 dose PPV23 0.5 mL IM or SQ x 1.
  • 6.6 Influenza A and B virus infection
  • Indication
  • All HIV-infected patients
  • Inactivated influenza vaccine annually (per recommendation for the season)
  • Live-attenuated influenza vaccine is contraindicated in HIV-infected patients.
  • 6.7 Syphilis
  • Prevention
  • Indication
  • For individuals exposed to a sex partner with a diagnosis of primary, secondary, or early latent syphilis within past 90 days.
  • For individuals exposed to a sex partner >90 days before syphilis diagnosis in the partner, if serologic test results are not available immediately and the opportunity for follow-up is uncertain.
  • Preferred regimen: Benzathine penicillin G 2.4 million units IM for 1 dose
  • Alternate regimen(1): Doxycycline 100 mg PO BID for 14 days
  • Alternate regimen(2): Ceftriaxone 1 g IM or IV daily for 8– 10 days.
  • Alternate regimen(3): Azithromycin 2 g PO for 1 dose (BII) – not recommended for MSM or pregnant women.
  • Treatment
  • Early Stage (Primary, Secondary, and Early-Latent Syphilis)
  • Preferred regimen: Benzathine penicillin G 2.4 million units IM for 1 dose
  • Alternate regimen: Doxycycline 100 mg PO BID for 14 days OR Ceftriaxone 1 g IM or IV daily for 10–14 days OR Azithromycin 2 g PO for 1 dose
  • Late-Stage (Tertiary–Cardiovascular or Gummatous Disease):
  • Preferred regimen: Benzathine penicillin G 2.4 million units IM weekly for 3 doses.
  • Alternate regimen: Doxycycline 100 mg PO BID for 28 days.
  • Neurosyphilis (Including Otic or Ocular Disease):
  • Preferred regimen: Aqueous crystalline penicillin G 18– 24 million units per day (administered as 3–4 million units IV q4h or by continuous IV infusion) for 10–14 days +/- benzathine penicillin G 2.4 million units IM weekly for 3 doses after completion of IV therapy.
  • Alternate regimen: Procaine penicillin 2.4 million units IM daily plus probenecid 500 mg PO QID for 10–14 days +/- benzathine penicillin G 2.4 million units IM weekly for 3 doses after completion.
  • Note:
  • The Jarisch-Herxheimer reaction is an acute febrile reaction accompanied by headache and myalgia that can occur within the first 24 hours after therapy for syphilis. This reaction occurs most frequently in patients with early syphilis, high nontreponemal titers, and prior penicillin treatment.


  • 6.8 Histoplasma capsulatum infection
  • Indication CD4 count ≤150 cells/µL and at high risk because of occupational exposure or live in a community with a hyperendemic rate of histoplasmosis (>10 cases/100 patient-years).
  • Preferred regimen:Itraconazole 200 mg PO daily.
  • 6.8 Coccidioidomycosis
  • Indication A new positive IgM or IgG serologic test in patients who live in a disease-endemic area and with CD4 count <250 cells/µL.
  • Preferred regimen: Fluconazole 400 mg PO daily.
  • 6.9 Herpes Simplex Virus (HSV) Disease
  • Orolabial Lesions (For 5–10 Days)
  • Preferred regimen: Valacyclovir 1 g PO BID OR Famciclovir 500 mg PO BID OR Acyclovir 400 mg PO TID
  • Initial or Recurrent Genital HSV (For 5–14 Days)
  • Preferred regimen: Valacyclovir 1 g PO BID OR Famciclovir 500 mg PO BID OR Acyclovir 400 mg PO TID.
  • Severe Mucocutaneous HSV
  • Preferred regimen: Initial therapy acyclovir 5 mg/kg IV q8h.
  • Note: After lesions begin to regress, change to PO therapy as above. Continue until lesions are completely healed.
  • Chronic Suppressive Therapy
  • Preferred regimen(1): Valacyclovir 500 mg PO BID
  • Preferred regimen(2): Famciclovir 500 mg PO BID
  • Preferred regimen(3): Acyclovir 400 mg PO BID


  • For Acyclovir-Resistant HSV
  • Preferred therapy: Foscarnet 80–120 mg/kg/day IV in 2–3 divided doses until clinical response.
  • Alternate regimen: IV cidofovir OR Topical trifluridine OR Topical trifluridine {[or}} Topical imiquimod for 21-28 days.
  • 6.10 Varicella-zoster virus (VZV) infection
  • Prevention
  • Indication
  • Pre-exposure prevention: Patients with CD4 counts ≥200 cells/µL who have not been vaccinated, have no history of varicella or herpes zoster, or who are seronegative for VZV.
  • Peferred regimen: Primary varicella vaccination (Varivax™), 2 doses (0.5 mL SQ each) administered 3 months apart.
  • Alternate regimen: VZV-susceptible household contacts of susceptible HIV-infected persons should be vaccinated to prevent potential transmission of VZV to their HIV-infected contacts.
  • Note:
  • If vaccination results in disease because of vaccine virus, treatment with acyclovir is recommended.
  • Routine VZV serologic testing in HIV-infected adults and adolescents is not recommended.
  • Post-exposure prevention:Close contact with a person with chickenpox or herpes zoster; and is susceptible (i.e., no history of vaccination or of either condition, or known to be VZV seronegative).
  • Preferred regimen: Varicella-zoster immune globulin (VariZIG™) 125 international units per 10 kg (maximum 625 international units) IM, administered as soon as possible and within 10 days after exposure.
  • Alternate regimen(1): Acyclovir 800 mg PO 5 x/day for 5– 7 days.
  • ALternate regimen(2): Valacyclovir 1 g PO TID for 5–7 days.
  • Note:
  • Individuals receiving monthly high-dose IVIG (>400 mg/kg) are likely to be protected if the last dose of IVIG was administered <3 weeks before exposure.
  • If antiviral therapy is used, varicella vaccines should not be given until at least 72 hours after the last dose of the antiviral drug.
  • Treatment
  • Primary Varicella Infection (Chickenpox)
  • Uncomplicated Cases (For 5–7 Days):
  • Preferred regimen: Valacyclovir 1 g PO TID OR Famciclovir 500 mg PO TID.
  • Severe or Complicated Cases
  • Preferred regimen: Acyclovir 10–15 mg/kg IV q8h for 7–10 days.
  • ALternaate regimen: Acyclovir 800 mg PO 5 times/day for 5-7 days.
  • Herpes Zoster (Shingles)
  • Acute Localized Dermatomal:
  • Preferred regimen(1): Valacyclovir 1 g PO TID for 7–10 days; consider longer duration if lesions are slow to resolve.
  • Preferred regimen(2): Famciclovir 500 mg TID for 7–10 days; consider longer duration if lesions are slow to resolve.
  • Extensive Cutaneous Lesion or Visceral Involvement:
  • Preferred regimen: Acyclovir 10–15 mg/kg IV q8h until clinical improvement is evident.
  • Note
  • May switch to PO therapy (valacyclovir, famciclovir, or acyclovir) after clinical improvement (i.e., when no new vesicle formation or improvement of signs and symptoms of visceral VZV), to complete a 10–14 day course.
  • Alternate regimen: Acyclovir 800 mg PO 5 times/day for 7–10 days; consider longer duration if lesions are slow to resolve.
  • Progressive Outer Retinal Necrosis (PORN):
  • Preferred regimen: (Ganciclovir 5 mg/kg +/- foscarnet 90 mg/kg) IV q12h + (ganciclovir 2 mg/0.05mL +/- foscarnet 1.2 mg/0.05 ml) intravitreal injection BIW.
  • Acute Retinal Necrosis (ARN)
  • Preferred regimen: (Acyclovir 10-15 mg/kg IV q8h) + (ganciclovir 2 mg/0.05mL intravitreal injection BIW X 1-2 doses) for 10-14 days, followed by valacyclovir 1g PO TID for 6 weeks.
  • 6.11 Cytomegalovirus (CMV) Disease
  • CMV Retinitis Induction Therapy:
  • Preferred regimen(1): Intravitreal injections of ganciclovir (2mg) or foscarnet (2.4mg) for 1-4 doses over a period of 7-10 days to achieve high intraocular concentration faster.
  • Preferred regimen(2): Valganciclovir 900 mg PO BID for 14–21 days.
  • Alternate regimen: Ganciclovir 5 mg/kg IV q12h for 14–21 days OR Foscarnet 90 mg/kg IV q12h or 60 mg/kg q8h for 14–21 days OR Cidofovir 5 mg/kg/week IV for 2 weeks; saline hydration before and after therapy and probenecid, 2 g PO 3 hours before dose, followed by 1 g PO 2 hours and 8 hours after the dose (total of 4 g).
  • Chronic Maintenance (Secondary Prophylaxis):
  • Valganciclovir 900 mg PO daily.
  • CMV Esophagitis or Colitis:
  • Preferred regimen: Ganciclovir 5 mg/kg IV q12h; may switch to valganciclovir 900 mg PO q12h once the patient can tolerate oral therapy for 21-42 days or till the symptoms are resolved.
  • Alternate regimen: Foscarnet 90 mg/kg IV q12h or 60 mg/kg q8h (BI) for patients with treatment-limiting toxicities to ganciclovir or with ganciclovir resistance for 21-42 days.
  • Alternate regimmen: Valganciclovir 900 mg PO q12h in milder disease and if able to tolerate PO therapy for 21-42 days.
  • CMV Neurological Disease
  • Preferred regimen: Ganciclovir 5 mg/kg IV q12h + (foscarnet 90 mg/kg IV q12h or 60 mg/kg IV q8h) to stabilize disease.
  • Chronic Maintenance (Secondary Prophylaxis):
  • Alternate regimen: Ganciclovir 5 mg/kg IV 5–7 times weekly OR Foscarnet 90–120 mg/kg IV once daily
  • 6.12 HHV-8 Diseases(Kaposi Sarcoma [KS], Primary Effusion Lymphoma [PEL], Multicentric Castleman’s Disease [MCD]).
  • Treatment
  • Mild To Moderate KS (ACTG Stage T0):
  • Mild To Moderate KS (ACTG Stage T0)
  • Advanced KS [ACTG Stage T1, Including Disseminated Cutaneous (AI) Or Visceral KS (BIII)]
  • Chemotherapy (per oncology consult) + ART
  • Primary Effusion Lymphoma
  • Chemotherapy (per oncology consult) + ART.
  • PO valganciclovir or IV ganciclovir can be used as adjunctive therapy.
  • Preferred regimen(1): Valganciclovir 900 mg PO BID for 3 weeks.
  • Preferred regimen(2): Ganciclovir 5 mg/kg IV q12h for 3 weeks.
  • Preferred regimen(3): Valganciclovir 900 mg PO BID + zidovudine 600 mg PO q6h for 7– 21 days.
  • Alternate regimen: Rituximab (375 mg/m2 given weekly for 4–8 weeks) may be an alternative to or used adjunctively with antiviral therapy.


  • 6.13 Human Papillomavirus (HPV) infection
  • Prevention
  • Preferred regimen(1): For females aged 13–26 years HPV quadrivalent vaccine 0.5 mL IM at months 0, 1–2, and 6 OR HPV bivalent vaccine 0.5 mL IM at months 0, 1–2, and 6.
  • Preferred regimen(2): Males aged 13–26 years HPV quadrivalent vaccine 0.5 mL IM at months 0, 1–2, and 6.
  • Treatment
  • Patient-Applied Therapy for Uncomplicated External Warts That Can Be Easily Identified by Patients:
  • Preferred regimen(1): Podophyllotoxin (e.g., podofilox 0.5% solution or 0.5% gel): Apply to all lesions BID for 3 consecutive days, followed by 4 days of no therapy, repeat weekly for up to 4 cycles, until lesions are no longer visible.
  • Preferred regimen(2): Imiquimod 5% cream: Apply to lesion at bedtime and remove in the morning on 3 nonconsecutive nights weekly for up to 16 weeks, until lesions are no longer visible. Each treatment should be washed with soap and water 6–10 hours after application.
  • Preferred regimen(3): Sinecatechins 15% ointment: Apply to affected areas TID for up to 16 weeks, until warts are completely cleared and not visible.
  • Provider-Applied Therapy for Complex or Multicentric Lesions, or Lesions Inaccessible to Patient.
  • Cryotherapy (liquid nitrogen or cryoprobe): Apply until each lesion is thoroughly frozen. Repeat every 1–2 weeks for up to 4 weeks, until lesions are no longer visible. Some providers allow the lesion to thaw, then freeze a second time in each session.
  • Trichloroacetic acid or bichloroacetic acid cauterization: 80%–90% aqueous solution, apply to wart only, allow to dry until a white frost develops. Repeat weekly for up to 6 weeks, until lesions are no longer visible.
  • Surgical excision or laser surgery to external or anal warts.
  • Podophyllin resin 10%–25% in tincture of benzoin: Apply to all lesions (up to 10 cm2 ), then wash off a few hours later, repeat weekly for up to 6 weeks until lesions are no longer visible.
  • 6.14. Hepatitis A virus (HAV) infection
  • Prevention
  • Indication: HAV-susceptible patients with chronic liver disease, or who are injection-drug users, or MSM.
  • Preferred regimen: Hepatitis A vaccine 1 mL IM x 2 doses at 0 and 6–12 months.
  • Alternate regimen: For patients susceptible to both HAV and hepatitis B virus (HBV) infection (see below): Combined HAV and HBV vaccine (Twinrix®), 1 mL IM as a 3-dose (0, 1, and 6 months) or 4-dose series (days 0, 7, 21 to 30, and 12 months).
  • Note:
  • IgG antibody response should be assessed 1 month after vaccination; nonresponders should be revaccinated when CD4 count >200 cells/µL.
  • 6.15Hepatitis B virus (HBV) infection
  • Prevention
  • Indication
  • Patients without chronic HBV or without immunity to HBV (i.e., anti-HBs <10 international units/mL).
  • Patients with isolated anti-HBc and negative HBV DNA.
  • Early vaccination is recommended before CD4 count falls below 350 cells/µL.
  • However, in patients with low CD4 cell counts, vaccination should not be deferred until CD4 count reaches >350 cells/µL, because some patients with CD4 counts <200 cells/µL do respond to vaccination.
  • Preferred regimen(1): HBV vaccine IM (Engerix-B 20 µg/mL or Recombivax HB 10 µg/mL), 0, 1, and 6 months.
  • Preferred regimen(2): HBV vaccine IM (Engerix-B 40 µg/mL or Recombivax HB 20 µg/mL) 0, 1, 2 and 6 months.
  • Preferred regimen(3): Combined HAV and HBV vaccine (Twinrix®), 1 mL IM as a 3-dose (0, 1, and 6 months) or 4-dose series (days 0, 7, 21 to 30, and 12 months).
  • Alternate regimen: Some experts recommend vaccinating with 40-µg doses of either HBV vaccine.
  • Note
  • Anti-HBs should be obtained 1 month after completion of the vaccine series. Patients with anti-HBs <10 international units/mL at 1 month are considered nonresponders.
  • Vaccine Non-Responders:
  • Indication
  • Anti-HBs <10 international units/mL 1 month after vaccination series.
  • For patients with low CD4 counts at time of first vaccine series, some experts might delay revaccination until after a sustained increase in CD4 count with ART.
  • Preferred regimen(1):Re-vaccinate with a second vaccine series.
  • Preferred regimen(2): HBV vaccine IM (Engerix-B 40 µg/mL or Recombivax HB 20 µg/mL), 0, 1, 2 and 6 months.
  • Treatment
  • Preferred regimen: ART regimen should include 2 drugs that are active against both HBV and HIV, such as [tenofovir 300 mg + emtricitabine 200 mg (or lamivudine 300 mg)] PO once daily (+ additional drug(s) for HIV).
  • For Patients Who Refuse or Are Unable to Take ART or Who Are HIV Long-Term Non-Progressors
  • Alternate regimen: For HBV treatment is indicated for patients with elevated ALT and HBV DNA >2,000 IU/mL significant liver fibrosis, advanced liver disease or cirrhosis Peginterferon alfa-2a 180 μg SQ once weekly for 48 weeks OR Peginterferon alfa 2b 1.5 μg/kg SQ once weekly for 48 weeks.
  • 6.16: Malaria
  • Prevention
  • Indication: Travel to disease-endemic area
  • Preferred regimen:
  • 6.17: Penicilliosis marneffei
  • Prevention:
  • Indication: Patients with CD4 cell counts <100 cells/µL who live or stay for a long period in rural areas in northern Thailand, Vietnam, or Southern China.
  • Preferred regimen: Itraconazole 200 mg once daily.
  • Alternate regimen: Fluconazole 400 mg PO once weekly.
  • Treatment:
  • For Acute Infection in Severely Ill Patients:
  • Preferred regimen: Liposomal amphotericin B 3–5 mg/kg/day IV for 2 weeks, followed by itraconazole 200 mg PO BID for 10 weeks (AII), followed by chronic maintenance therapy (as below).
  • Alternate regimen: Voriconazole 6 mg/kg IV q12h for 1 day, then 4 mg/kg IV q12h for at least 3 days, followed by 200 mg PO BID for a maximum of 12 weeks (BII), followed by maintenance therapy.
  • For Mild Disease
  • Preferred regimen: Itraconazole 200 mg PO BID for 8 weeks (BII); followed by chronic maintenance therapy.
  • Alternaate regimen: Voriconazole 400 mg PO BID for 1 day, then 200 mg BID for a maximum of 12 weeks (BII), followed by chronic maintenance therapy.
  • Chronic Maintenance Therapy (Secondary Prophylaxis):
  • Itraconazole 200 mg PO daily.
  • Note:
  • ART should be initiated simultaneously with treatment for penicilliosis to improve treatment outcome.
  • Itraconazole and voriconazole may have significant interactions with certain ARV agents. These interactions are complex and can be bi-directional.
  • Therapeutic drug monitoring and dosage adjustment may be necessary to ensure triazole antifungal and ARV efficacy and reduce concentration-related toxicities.
  • 6.18: Isosporiasis
  • Treatment:
  • For Acute Infection:
  • Preferred regimen(1): TMP-SMX (160 mg/800 mg) PO (or IV) QID for 10 days.
  • Preferred regimen(2): TMP-SMX (160 mg/800 mg) PO (or IV) BID for 7–10 days.
  • Alternate regimen(1): Pyrimethamine 50–75 mg PO daily + leucovorin 10–25 mg PO daily.
  • Alternate regimen(2): Ciprofloxacin 500 mg PO BID for 7 days as a second line alternative.
  • Chronic Maintenance Therapy (Secondary Prophylaxis):
  • Preferred regimen(1): In patients with CD4 count <200/µL, TMP-SMX (160 mg/800 mg) PO TIW
  • Alternate regimen(1): TMP-SMX (160 mg/800 mg) PO daily or (320 mg/1600 mg) TIW
  • Alternate regimen(2): Pyrimethamine 25 mg PO daily + leucovorin 5–10 mg PO daily.
  • Alternate regimen(3): Ciprofloxacin 500 mg TIW as a second-line alternative.
  • Note:
  • Fluid and electrolyte management in patients with dehydration.
  • Immune reconstitution with ART may result in fewer relapses.
  • IV therapy may be used for patients with potential or documented mal-absorption.
  • 6.19: Chagas Disease (American Trypanosomiasis)
  • Treatment
  • For Acute, Early Chronic, and ReActivated Disease:
  • Preferred regimen: For Acute, Early Chronic, and ReActivated Disease.
  • Allternate regimen: Nifurtimox 8–10 mg/kg/day PO for 90–120 days.
  • 6.20: Leishmaniasis, visceral
  • Leishmaniasis, visceral
  • Treatment
  • For Initial Infection:
  • Preferred regimen(1): Liposomal amphotericin B 2–4 mg/kg IV daily.
  • Preferred regimen(2): Liposomal amphotericin B interrupted schedule (e.g., 4 mg/kg on days 1–5, 10, 17, 24, 31, 38).
  • Alternate regimen(1): Amphotericin B deoxycholate 0.5–1.0 mg/kg IV daily for total dose of 1.5–2.0 g.
  • Alternate regimen(2): Sodium stibogluconate (pentavalent antimony) 20 mg/kg IV or IM daily for 28 days.
  • Alternate regimen(3): Miltefosine 100 mg PO daily for 4 weeks (available in the United States under a treatment IND)
  • Chronic Maintenance Therapy (Secondary Prophylaxis); Especially in Patients with CD4 Count <200 cells/µL:
  • Preferred regimen(1): Liposomal amphotericin B 4 mg/kg every 2–4 weeks.
  • Preferred regimen(2): Amphotericin B lipid complex 3 mg/kg every 21 days.
  • Alternate regimen: Sodium stibogluconate 20 mg/kg IV or IM every 4 weeks.
  • Leishmaniasis, cutaneous
  • Preferred regimen(1): Liposomal amphotericin B 2–4 mg/kg IV daily for 10 days.
  • Preferred regimen(2): Liposomal amphotericin B interrupted schedule (e.g., 4 mg/kg on days 1–5, 10, 17, 24, 31, 38) to achieve total dose of 20–60 mg/kg.
  • Preferred regimen(3): Sodium stibogluconate 20 mg/kg IV or IM daily for 3–4 weeks.
  • 6.21: Aspergillosis, invasive
  • Treatment.
  • Preferred regimen: Voriconazole 6 mg/kg IV q12h for 1 day, then 4 mg/kg IV q12h, followed by voriconazole 200 mg PO q12h after clinical improvement until CD4 cell count >200 cells/µL and the infection appears to be resolved.
  • Alternate regimen: Lipid formulation of amphotericin B 5 mg/kg IV daily OR Amphotericin B deoxycholate 1mg/kg IV daily OR Caspofungin 70 mg IV 1 time, then 50 mg IV daily OR Micafungin 100–150 mg IV daily OR Anidulafungin 200 mg IV 1 time, then 100 mg IV daily OR Posaconazole 200 mg PO QID, then, after condition improved, 400 mg PO BID.
  • 6.22: Coccidioidomycosis
  • Treatment
  • Clinically Mild Infections (e.g., Focal Pneumonia)
  • Preferred regimen: Fluconazole 400 mg PO daily OR Itraconazole 200 mg PO BID
  • Alternate regimen: Posaconazole 200 mg PO BID OR Voriconazole 200 mg PO BID
  • Severe, Non-Meningeal Infection (Diffuse Pulmonary Infection or Severely Ill Patients with Extrathoracic, Disseminated Disease)
  • Preferred regimen: Amphotericin B deoxycholate 0.7–1.0 mg/kg IV daily OR Lipid formulation amphotericin B 4–6 mg/kg IV daily
  • Alternate regimen: Fluconazole or itraconazole, with itraconazole preferred for bone disease 400 mg per day to amphotericin B therapy and continue triazole once amphotericin B is stopped.
  • Meningeal Infections
  • Preferred regimen: Fluconazole 400–800 mg IV or PO daily
  • Alternate regimen: Itraconazole 200 mg PO TID for 3 days, then 200 mg PO BID OR Posaconazole 200 mg PO BID OR Voriconazole 200–400 mg PO BID
  • Chronic Suppressive Therapy
  • Preferred regimen: Fluconazole 400 mg PO daily OR Itraconazole 200 mg PO BID
  • Alternate regimen: Posaconazole 200 mg PO BID OR Voriconazole 200 mg PO BID
  • Note
  • Therapy should be continued indefinitely in patients with diffuse pulmonary or disseminated diseases because relapse can occur in 25%–33% of HIV-negative patients. It can also occur in HIV-infected patients with CD4 counts >250 cells/µL.
  • Therapy should be lifelong in patients with meningeal infections because relapse occurs in 80% of HIV-infected patients after discontinuation of triazole therapy.
  • 6.23: Histoplasmosis
  • Treatment
  • Moderately Severe to Severe Disseminated Disease
  • Preferred regimen:
  • Induction Therapy (for at least 2 weeks or until clinically improved): Liposomal amphotericin B 3 mg/kg IV daily
  • Maintenance Therapy: Itraconazole 200 mg PO TID for 3 days, then 200 mg PO BID.
  • Less Severe Disseminated Disease
  • Induction and Maintenance Therapy
  • Preferred regimen: Itraconazole 200 mg PO TID for 3 days, then 200 mg PO BID for 12 months.
  • Alternate regimen
  • Induction Therapy (for at least 2 weeks or until clinically improved): Amphotericin B lipid complex 3 mg/kg IV daily OR Amphotericin B cholesteryl sulfate complete 3 mg/kg IV daily.
  • Alternatives to Itraconazole for Maintenance Therapy or Treatment of Less Severe Disease: Voriconazole 400 mg PO BID for 1 day, then 200 mg BID OR Posaconazole 400 mg PO BID OR Fluconazole 800 mg PO daily.
  • Meningitis
  • Preferred regimen:
  • Induction Therapy (4–6 weeks): Liposomal amphotericin B 5 mg/kg/day
  • Maintenance Therapy: Itraconazole 200 mg PO BID to TID for ≥1 year and until resolution of abnormal CSF findings.
  • Long-Term Suppression Therapy
  • Preferred regimen: Itraconazole 200 mg PO daily
  • Alternate regimen: Fluconazole 400 mg PO daily.
  • Note
  • Therapeutic drug monitoring and dosage adjustment may be necessary to ensure triazole antifungal and ARV efficacy and reduce concentration-related toxicities.
  • 6.24: Cryptococcosis
  • Treatment
  • Cryptococcal Meningitis
  • Preferred regimen
  • Induction Therapy (for at least 2 weeks, followed by consolidation therapy): Liposomal amphotericin B 3–4 mg/kg IV daily AND flucytosine 25 mg/kg PO QID
  • Alternate regimen
  • Induction Therapy (for at least 2 weeks, followed by consolidation therapy): Amphotericin B deoxycholate 0.7 mg/kg IV daily + flucytosine 25 mg/kg PO QID OR Amphotericin B lipid complex 5 mg/kg IV daily + flucytosine 25 mg/kg PO QID OR Liposomal amphotericin B 3-4 mg/kg IV daily + fluconazole 800 mg PO or IV daily OR Amphotericin B deoxycholate 0.7 mg/kg IV daily + fluconazole 800 mg PO or IV daily OR Fluconazole 400–800 mg PO or IV daily + flucytosine 25 mg/kg PO QID OR Fluconazole 1200 mg PO or IV daily.
  • Consolidation Therapy (for at least 8 weeks (AI), followed by maintenance therapy)
  • Preferred regimen: Fluconazole 400 mg PO (or IV) daily
  • Alternate regimen: Itraconazole 200 mg PO BID for 8 weeks.
  • Non-CNS Cryptococcosis with Mildto-Moderate Symptoms and Focal Pulmonary Infiltrates:
  • Preferred regimen: Fluconazole, 400 mg PO daily for 12 months.
  • Note:
  • Patients receiving flucytosine should have either blood levels monitored (peak level 2 hours after dose should be 30–80 mcg/mL) or close monitoring of blood counts for development of cytopenia. Dosage should be adjusted in patients with renal insufficiency.
  • 6.25: Mucocutaneous candidiasis
  • Treatment
  • For Oropharyngeal Candidiasis; Initial Episodes (For 7–14 Days):
  • Oral Therapy
  • Preferred regimen: Fluconazole 100 mg PO daily
  • Alternate regimen: Itraconazole oral solution 200 mg PO daily OR Posaconazole oral suspension 400 mg PO BID for 1 day, then 400 mg daily
  • Topical therapy
  • Preferred regimen: Clotrimazole troches, 10 mg PO 5 times daily OR Miconazole mucoadhesive buccal 50-mg tablet—apply to mucosal surface over the canine fossa once daily (do not swallow, chew, or crush).
  • Alternate regimen: Nystatin suspension 4–6 mL QID or 1–2 flavored pastilles 4– 5 times daily.
  • For Esophageal Candidiasis (For 14–21 Days):
  • Preferred regimen: Fluconazole 100 mg (up to 400 mg) PO or IV daily OR Itraconazole oral solution 200 mg PO daily.
  • Alternate regimen: Voriconazole 200 mg PO or IV BID OR Anidulafungin 100 mg IV 1 time, then 50 mg IV daily OR Caspofungin 50 mg IV daily OR Micafungin 150 mg IV daily OR Amphotericin B deoxycholate 0.6 mg/kg IV daily OR Lipid formulation of amphotericin B 3–4 mg/kg IV daily.
  • For Uncomplicated Vulvo-Vaginal Candidiasis:
  • Preferred regimen: Oral fluconazole 150 mg for 1 dose OR Topical azoles (clotrimazole, butoconazole, miconazole, tioconazole, or terconazole) for 3– 7 days.
  • Alternate regimen: Itraconazole oral solution 200 mg PO daily for 3–7 days.
  • For Severe or Recurrent VulvoVaginal Candidiasis:
  • Preferred regimen: Fluconazole 100–200 mg PO daily for ≥7 days OR Topical antifungal ≥7 days.
  • 6:26. Bartonellosis
  • Treatment
  • For Bacillary Angiomatosis, Peliosis Hepatis, Bacteremia, and Osteomyelitis
  • Preferred regimen: Doxycycline 100 mg PO or IV q12h OR Erythromycin 500 mg PO or IV q6h for 3 months.
  • Alternate regimen: Azithromycin 500 mg PO daily OR Clarithromycin 500 mg PO BID.
  • Confirmed Bartonella Endocarditis:
  • Preferred regimen: (Doxycycline 100 mg IV q12h + gentamicin 1 mg/kg IV q8h) for 2 weeks, then continue with doxycycline 100 mg IV or PO q12h
  • Altered regimen: (Doxycycline 100 mg IV + RIF 300 mg PO or IV) q12h for 2 weeks, then continue with doxycycline 100 mg IV or PI q12h
  • CNS Infections:
  • Preferred regimen: (Doxycycline 100 mg +/- RIF 300 mg) PO or IV q12h
  • Other Severe Infections:
  • Preferred regimen: (Doxycycline 100 mg PO or IV +/- RIF 300 mg PO or IV) q12h OR (Erythromycin 500 mg PO or IV q6h) +/- RIF 300 mg PO or IV q12h for 3 months.
  • Note
  • If relapse occurs after initial (>3 month) course of therapy, longterm suppression with doxycycline or a macrolide is recommended as long as CD4 count <200 cells/µL.
  • 6:27. Campylobacteriosis
  • Treatment
  • For Mild-to-Moderate Disease (If Susceptible):
  • Preferred regimen: Ciprofloxacin 500–750 mg PO (or 400 mg IV) q12h OR Azithromycin 500 mg PO daily
  • Alternate regimen: Levofloxacin 750 mg (PO or IV) q24h OR Moxifloxacin 400 mg (PO or IV) q24h.
  • For Campylobacter Bacteremia
  • Preferred regimen: Ciprofloxacin 500–750 mg PO (or 400 mg IV) q12h (BIII) + an aminoglycoside.
  • Duration of Therapy:
  • Gastroenteritis: 7–10 days (5 days with azithromycin)
  • Bacteremia: ≥14 days
  • Recurrent bacteremia: 2–6 weeks.
  • 6:28 Shigellosis
  • Treatment
  • Preferred regimen: Ciprofloxacin 500–750 mg PO (or 400 mg IV) q12h
  • Duration of Therapy:
  • Gastroenteritis: 7–10 days • Bacteremia: ≥14 days • Recurrent Infections: 2–6 weeks
  • Alternate regimen: Levofloxacin 750 mg (PO or IV) q24h OR Moxifloxacin 400 mg (PO or IV) q24h OR TMP 160 mg-SMX 800 mg (PO or IV) q12h OR Azithromycin 500 mg PO daily for 5 days.
  • Note
  • Antimotility agents should be avoided



















Bronchiolitis

Treatment

Note[2]

Prophylaxis

Note
  • Clinicians should administer palivizumab during the first year of life to infants with hemodynamically significant heart disease or chronic lung disease of prematurity defined as preterm infants <32 weeks 0 days’ gestation who require >21% oxygen for at least the first 28 days of life.
  • Clinicians should not administer palivizumab to otherwise healthy infants with a gestational age of 29 weeks, 0 days or greater.
  • All people should disinfect hands before and after direct contact with patients, after contact with inanimate objects in the direct vicinity of the patient, and after removing gloves.
  • All people should use alcoholbased rubs for hand decontamination when caring for children with bronchiolitis. When alcoholbased rubs are not available, individuals should wash their hands with soap and water.
  • Clinicians should counsel caregivers about exposing the infant or child to environmental tobacco smoke and smoking cessation when assessing a child for bronchiolitis.


Influenza

Treatment

  • Preferred Regimen(1): Zanamivir 10 mg (two 5-mg inhalations) BID for 5 days.
  • Preferred Regimen(2): Oseltamivir 75 mg BID for 5 days.
  • Preferred Regimen(3): Peramivir 600 mg dose, IV for 15-30 minutes for 1 day.

Prophylaxis

  • The chemoprophylaxis dosage of Zanamivir is 10 mg (2 inhalations) once a day.
  • The chemoprophylaxis of Oseltamivir is from 3 months and older age group.
  • Pediatric dose
Oseltamivir
  • If younger than 1 yr old1:
  • 3 mg/kg/dose twice daily2,3
  • If 1 yr or older, dose varies by child’s weight:
  • 15 kg or less, the dose is 30 mg twice a day
  • >15 to 23 kg, the dose is 45 mg twice a day>23 to 40 kg, the dose is 60 mg twice a day>40 kg, the dose is 75 mg twice a day.
Zanamivir
  • 10 mg (two 5-mg inhalations) twice daily
(FDA approved and recommended for use in children 7 yrs or older).

Dosing in Adult Patients with Renal Impairment

  • Oral oseltamivir
  • Recommended Treatment Regimen- 75 mg BID
  • Recommended Chemoprophylaxis Regimen- 75 mg qd
  • Recommended Treatment Regimen- 30 mg BID
  • Recommended Chemoprophylaxis Regimen- 30 mg qd
  • Recommended Treatment Regimen- 30 mg qd
  • Recommended Chemoprophylaxis Regimen- 30 mg every other day
  • Recommended Treatment Regimen- 30 mg after every hemodialysis cycle. Treatment duration not to exceed 5 days
  • Recommended Chemoprophylaxis Regimen- 30 mg after alternate hemodialysis cycles.
  • ESRD Patients on Continuous Ambulatory Peritoneal Dialysis Creatinine clearance ≤10 mL/min.
  • Recommended Treatment Regimen- A single 30 mg dose administered immediately after a dialysis exchange
  • Recommended Chemoprophylaxis Regimen- 30 mg once weekly immediately after dialysis exchange
  • Recommended Chemoprophylaxis Regimen- 30 mg after alternate hemodialysis cycles.

Note:

  • Early treatment of hospitalized patients can reduce death.
  • An emphasis on close monitoring and early initiation of antiviral treatment if fever and/or respiratory symptoms develop is an alternative to chemoprophylaxis after a suspected exposure for some persons.
  • To be effective as chemoprophylaxis, an antiviral medication must be taken each day for the duration of potential exposure to a person with influenza and continued for 7 days after the last known exposure. For persons taking antiviral chemoprophylaxis after inactivated influenza vaccination, the recommended duration is until immunity after vaccination develops (antibody development after vaccination takes about two weeks in adults and can take longer in children depending on age and vaccination history).
  • Antiviral chemoprophylaxis generally is not recommended if more than 48 hours have elapsed since the first exposure to an infectious person.
  • Patients receiving antiviral chemoprophylaxis should be encouraged to seek medical evaluation as soon as they develop a febrile respiratory illness that might indicate influenza.
  • Zanamivir is contraindicated in patients with history of allergy to milk protein.
  • Oral oseltamivir is preferred for treatment of pregnant women.
  • For control of outbreaks in institutional settings (e.g. long-term care facilities for elderly persons and children) and hospitals, CDC recommends antiviral chemoprophylaxis for a minimum of 2 weeks, and continuing up to 1 week after the last known case was identified. Antiviral chemoprophylaxis is recommended for all residents, including those who have received influenza vaccination, and for unvaccinated institutional employees.

Empyema

Culture negative pleural infection

  • Preferred regimen: Cefuroxime 1.5 g IV q8h AND Metronidazole 500 mg IV q8h OR Template:Benzyl penicillin 1.2 g IV q6h PLUS Ciprofloxacin 400 mg IV q12h OR meropenem 1 g IV q8h PLUS metronidazole 500 mg q8h.[3]
  • Preferred regimen(2): Amoxycillin 1 g oral q8h PLUS clavulanic acid 125 mg oral q8h PLUS metronidazole 400mg oral q8h OR clindamycin 300 mg oral q8h.LastName, FirstName (2007). Sanford guide to antimicrobial therapy. Place of publication not identified: Antimicrobial Therapy. ISBN 9781930808386.

For culture negative hospital acquired infection

  • Preferred regimen: Piperacillin 3 gm IV q4h PLUS tozobactam 4.5g IV q6h OR ceftazidime 2g IV q8h OR meropenem 1g IV q8h PLUS metronidazole 500mg q8h.

Pathogen based empyema

Strep. pneumoniae, Group A strep

  • Preferred regimen(1):Ceftriaxone ≤30 days old, 75 mg/kg IV/IM q24h (use with caution in infants with jaundice) or >30 days old 100 mg/kg IV/IM q24h

Staph. aureus

H. influenzae

Subacute/chronic empyema

Anaerobic strep, Strep. milleri, Bacteroides sp., Enterobacteriaceae, M. tuberculosis

  • Preferred regimen: Clindamycin 450–900 mg IV q8h + Ceftriaxone
  • Alternate regimen: Cefoxitin or IMP or TC-CL or PIP-TZ or AM-SB

References

  1. ↑ "AIDSinfoNIH".
  2. ↑ Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Baley JE, Gadomski AM; et al. (2014). "Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis". Pediatrics. 134 (5): e1474–502. doi:10.1542/peds.2014-2742. PMID 25349312.
  3. ↑ Ahmed AE, Yacoub TE (2010). "Empyema thoracis". Clin Med Insights Circ Respir Pulm Med. 4: 1–8. PMC 2998927. PMID 21157522.
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