Cotrimoxazole Prophylaxis

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Cotrimoxazole (trimethoprim-sulfamethoxazole) prophylaxis provides protection against some but not all severe bacterial infections and has been shown to prolong life and reduce hospital admissions. 

Cotrimoxazole prophylaxis should be given to the following: 

  • All patients with WHO clinical stages 2,3 and 4 disease
  • All patients with CD4 counts equal or less than 350cells/mm3
  • Pregnant women with CD4 counts equal or less than 350 cells/mm3
  • All children born to HIV positive mothers from six weeks of age until they are tested and confirmed to be HIV negative
  • Cotrimoxazole prophylaxis should be started as soon as any of the above conditions are suspected; this should be done at every entry point and not just be left to the OI clinics
  • Cotrimoxazole prophylaxis must be stopped when patients become clinically stable and are virally suppressed below 1000 copies/mL for those patients who have been on ART for at least 6 months.  

Medicine

Adult dose

Frequency

Duration

Cotrimoxazole po

960mg

Once a day

Until CD4> 350cells/mm3 for 6 months with ARVs or VL is less than 1000 copies per ml for at least 6 months

Cotrimoxazole prophylaxis in children

Give once daily orally according to the following table: 

Age

Dose (ml)

Suspension (240mg/5mL)

Paediatric tablets (120mg)

Up to 6 months

2.5

1

6 months to 3 years

5

2

Over 3 years

10

4

Give cotrimoxazole for the duration of the paediatric life. 

If allergic to cotrimoxazole, try desensitization. 

Consider using dapsone or desensitization. Desensitization can be offered rapidly or over a longer period of time. Do not desensitize anyone who has had an anaphylactic reaction to cotrimoxazole or a severe skin rash such as Steven-Johnson syndrome.