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HIV and Its Complications and Needlestick Injuries
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
If oxygen saturation (SpO2) <92%, treat as severe PCP with 40 mg prednisolone twice daily on days 1–5, 40 mg once daily on days 6–11 and 20 mg once daily on days 11–21 or methylprednisolone IV if unable to tolerate orally. Treat moderate-to-severe PCP with co-trimoxazole IV for 21 days (120 mg/kg for first 3 days, then 90 mg/kg IV) in three divided doses and mild–moderate disease with oral 90 mg/kg co-trimoxazole in three divided doses. Side effects of co-trimoxazole include rash (mild to severe, e.g. Stevens–Johnson syndrome), headache, nausea, mouth ulcers and jaundice. Second-line and alternative treatment options for those with sulfa allergy, toxicity or non-response after 5 days on anti-PCP treatment include 600 mg clindamycin IV three times daily with 15 mg primaquine orally once daily (must check for glucose-6-phosphate dehydrogenase [G6PD] deficiency first), 4 mg/kg pentamidine IV once daily or 750 mg atovaquone orally twice daily.
Infections
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Trimethoprim, like sulphonamides, also prevents the synthesis of THFA, but at a later stage by inhibiting dihydrofolate reductase. Trimethoprim is often given in combination with sulphamethoxazole (cotrimoxazole). The advantages of this combination over either drug alone are: mutant bacteria which are resistant to one agent are unlikely to be resistant to the other, i.e double mutation;the two agents act synergistically against some bacteria.
Connective tissue disease
Published in Catherine Nelson-Piercy, Handbook of Obstetric Medicine, 2020
The major first-line therapeutic agents are cyclophosphamide and rituximab. Plasma exchange may be used for rapidly progressive disease. In pregnancy, the mainstays of treatment are prednisolone and azathioprine. Co-trimoxazole (septrin = trimethoprim + sulphamethoxazole) or erythromycin may be used to reduce bacterial carriage in the nose and reduce flare. If co-trimoxazole is used in pregnancy, it must be given with high-dose (5 mg) folic acid.
Acute bacterial skin and skin structure infections in pediatric patients: potential role of dalbavancin
Published in Expert Review of Anti-infective Therapy, 2023
Lorenzo Volpicelli, Mario Venditti, Alessandra Oliva
Cotrimoxazole is a 1:5 combination of two agents blocking sequential steps of bacterial nucleic acid biosynthesis: trimethoprim, a pyrimidine analog, and the sulfonamide sulfamethoxazole. Administration may be either orally or intravenously, and the spectrum is wide, including specific pathogens like Nocardia, Pneumocystis, and Cyclospora and common syndromes like urinary tract infections and gastroenteritis. In a systematic review of studies concerning cotrimoxazole prescription for SSTIs, children represented most of the overall population and, although meta-analysis was not performable due to heterogeneity, the results supported the efficacy of this drug both for streptococcal and staphylococcal etiologies [26]. However, from 2005 to 2017, an increasing rate of resistance to cotrimoxazole was described in MRSA isolates, from 2% to 13% [23].
Prevalence of kidney injury in patients taking tenofovir based antiretroviral therapy at a primary health care clinic, in East Rand,Gauteng Province
Published in Hospital Practice, 2021
P Makamu, S Bezuidenhout, M Matlala
The most common medications co-administered to patients were the angiotensin-converting enzyme inhibitor, mainly enalapril. Cotrimoxazole antibiotic was used as a preventative therapy for Pneumocystis pneumonia, bacteremia, isosporiasis, toxoplasmosis, and bacterial pneumonia in patients in WHO stages II, III and IV or patients with CD4-T cells count below 200cells/mm3 [8]. Angiotensin-converting enzyme inhibitors are known to cause hemodynamically mediated kidney injury, whilst cotrimoxazole is associated with intratubular obstruction and nephrolithiasis [38]. Nevertheless, all six affected patients were not taking any antihypertensive medication. Furthermore, these patients were taking a prophylactic therapy of cotrimoxazole 960 mg daily. It is therefore possible that cotrimoxazole could have contributed to the progression into renal injury.
Prevalence of bacterial pneumonia among HIV-Seropositive patients in East Africa: Review
Published in Cogent Medicine, 2021
Treatment of pneumonia by commonly used drugs has been complicated the selection of medication due to rapid development of drug resistance (Salzer et al., 2018). The principle of bacterial pneumonia treatment in HIV positive individuals is similar to that in individuals without HIV infection (Sisay et al., 2018). Different researchers in the previous time indicated that penicillin is cost-effective in the treatment of pneumonia before the outbreak of HIV infection in Africa (Bhutta et al., 2013; Enarson et al., 2014). A study done in India also showed that penicillin is the cost effective antibiotic to treat pneumonia in developing countries. For more than half a century, penicillin has been used as the standard drug for treating pneumonia infection (Harboe et al., 2014). WHO recommended that cotrimoxazole is a prophylactic agent against opportunistic infections among HIV/AIDS infected patients (Sisay et al., 2018). However, a study done in Ethiopia reported that 70.8% of bacterial isolates were resistant to cotrimoxazole (Genetu & Zenebe, 2020). A respiratory fluoroquinolone is an alternative to the beta-lactam in individuals who are allergic to penicillin and doxycycline is an alternative to the macrolide (Kaysin & Viera, 2016). However, the clinical effectiveness of short-term parenteral therapy against bacterial pneumonia in HIV-infected and HIV-uninfected patients with HIV-endemic, in developing countries is not well documented (Jones & Berkley, 2014).