Alternative treatment for children with low- to moderate-severity PJP

For children with low- to moderate-severity PJP who have hypersensitivity to trimethoprim+sulfamethoxazole, useCooley 2014Panel on Opportunistic infections in HIV-exposed and HIV-infected children 2022:

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child younger than 3 months: 15 to 20 mg/kg orally with full-fat milk or feeds, 12-hourly for 21 days

child 3 to 24 months: 22.5 mg/kg orally with fatty food or full-fat milk, 12-hourly for 21 days

child older than 24 months: 15 to 20 mg/kg up to 750 mg orally with fatty food or full-fat milk, 12-hourly for 21 days.

Other regimens (eg dapsone plus trimethoprim) may be suitable for children with nonsevere hypersensitivity to trimethoprim+sulfamethoxazole – seek expert advice. Do not give dapsone to children with severe1 hypersensitivity to trimethoprim+sulfamethoxazole because there is a possibility of cross-reactivity between dapsone and sulfamethoxazole.

After completing 21 days of therapy, maintenance therapy (secondary prophylaxis) for PJP may be required for children with immune compromise (eg patients with HIV infection or cancer, organ transplant recipients).

1 Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse. Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return