Reconsidering empirical cotrimoxazole prophylaxis for infants exposed to HIV infection.
نویسندگان
چکیده
Infants with HIV infection are vulnerable to Pneumocystis carinii pneumonia (PCP) during their first year of life. WHO and the Joint United Nations Programme on HIV/AIDS now recommend that all children of HIV-positive mothers receive prophylactic cotrimoxazole against PCP from six weeks of age and continue this therapy until exposure through breast milk ceases-and the infant is confirmed to be HIV-negative (rarely before one year of age). Empirical prophylaxis invokes a trade-off between possible benefit to the infant versus the risk of resistance to antibiotics and antimalarials. From a critical analysis of the literature, we offer a conceptual model demonstrating how, under certain circumstances, a policy of mass cotrimoxazole prophylaxis may be counterproductive.
منابع مشابه
Cotrimoxazole Prophylaxis and Risk of Severe Anemia or Severe Neutropenia in HAART-Exposed, HIV-Uninfected Infants
BACKGROUND Prophylactic cotrimoxazole is recommended for infants born to HIV-infected mothers. However, cotrimoxazole may increase the risk of severe anemia or neutropenia. METHODS We compared the proportion of HIV-exposed uninfected (HIV-EU) infants experiencing incident severe anemia (and separately, severe neutropenia) between a prospective cohort receiving prophylactic cotrimoxazole from ...
متن کاملCotrimoxazole prophylaxis for infants exposed to HIV infection.
1 Clinical Research Fellow, Malawi-Liverpool-Wellcome Trust Clinical Research Programme and Department of Paediatrics, College of Medicine University of Malawi, Malawi ([email protected]). Tel: 265-1-676444; Fax: 265-1-675774. Ref. No. 03-010397 Uncertainty remains about the risks and benefits of implementing guidelines on the use of cotrimoxazole prophylaxis for prevention of HIV-related i...
متن کاملFactors Associated with Coverage of Cotrimoxazole Prophylaxis in HIV-Exposed Children in South Africa
BACKGROUND The World Health Organisation and the Joint United Nations Programme in 2006 reaffirmed the earlier recommendation of 2000 that all HIV-exposed infants in resource-poor countries should commence cotrimoxazole (CTX) prophylaxis at 6-weeks of life. CTX prophylaxis should be continued until the child is confirmed HIV-uninfected and there is no further exposure to breastmilk transmission...
متن کاملCotrimoxazole prophylaxis was associated with enteric commensal bacterial resistance among HIV‐exposed infants in a randomized controlled trial, Botswana
INTRODUCTION Despite declining risk of vertical HIV transmission, prophylactic cotrimoxazole (CTX) remains widely used to reduce morbidity and mortality in the event of HIV infection among exposed infants, with an inherent risk of conferring commensal antimicrobial resistance. Using data from a randomized, placebo-controlled trial of infant CTX prophylaxis, we sought to quantify emergence of an...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
- Bulletin of the World Health Organization
دوره 82 4 شماره
صفحات -
تاریخ انتشار 2004