title: Reconsidering empirical cotrimoxazole prophylaxis for infants exposed to HIV infection.
abstract: 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.
authors.affiliation: Department of International Health, Center for International Health and Development, Boston University School of Public Health, Boston, MA, USA. cgill@bu.edu
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Gill
authors.forename: Lora L
authors.initials: LL
authors.lastname: Sabin
authors.forename: Joseph
authors.initials: J
authors.lastname: Tham
authors.forename: Davidson H
authors.initials: DH
authors.lastname: Hamer
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D000349:Africa / Q000453:epidemiology; D000890:Anti-Infective Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D001942:Breast Feeding / Q000009:adverse effects; D018890:Chemoprevention; D004351:Drug Resistance; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011020:Pneumonia, Pneumocystis / Q000209:etiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D014944:World Health Organization
chemical_list: D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination