Table 7-11: Opportunistic Infections and Primary Prophylaxis in Pregnant Women
| Pathogen |
Indication |
Regimen |
Alternatives |
| Strongly Recommended |
| Pneumocystis carinii |
CD4<200/mm3 or oral thrush |
TMP-SMZ DS 1 po qd TMP-SMZ SS 1 po qd |
Dapsone 50 mg po bid
Dapsone 100 mg po qd
Aerosolized pentamidine (AP) 300 mg q mo (via Respirgard II nebulizer)
TMP-SMZ DS 1 po tiw |
Some providers may prefer to use AP in first trimester because of lack of systemic absorption and fetal exposure, secondary to theoretical concerns about possible teratogenicity with systemic medications.
Criteria for stopping primary prophylaxis: CD4 > 200/mm3 for  3 mo. |
Mycobacterium tuberculosis
INH-sensitive
INH-resistant
multidrug (INH and rifampin) resistant |
TST reaction 5mm or prior positive TST without treatment or contact with active TB
Same; high probability of exposure to INH-resistant M. tuberculosis
Same; high probability of exposure to multidrug M. tuberculosis |
INH 300 mg po qd plus pyridoxine 50 mg po qd x 9 mo
INH 900 mg po biw plus pyridoxine 100 mg po biw x 9 mo
Rifampin 600mg po qd x 4 mo. |
Rifampin 600 mg po qd x 4 mo |
Some providers may choose to initiate phrophylaxis after the first trimester, because of concerns about possible teratogenicity. Anecdotal experience with rifampin has not been associated with adverse pregnancy outcomes. Pyrazinamide should generally be avoided, particularly in the first trimester, because of lack of information concerning fetal effects. INH use during pregnancy has been associated with elevated risk for hepatotoxicity and LFTs should be monitored.
Choice of drugs requires consultation with obstetric experts and public health authorities.
Consult with obstetric experts and public health authorities if alternative regimen required |
| Toxoplasma gondii |
IgG antibody to Toxoplasma
and
CD4 <100/mm3 |
TMP-SMZ DS 1
po qd |
TMP-SMZ SS 1 po qd |
If patient cannot tolerate TMP-SMZ, the recommended alternative is dapsone-pyrimethamine-leucovorin; however, because of the low incidence of TE during pregnancy and possible fetal risk with pyrimethamine, chemoprophylaxis may reasonably be deferred until after pregnancy
Criteria for stopping primary prophylaxis: CD4 > 200/mm3 for 3 mo. |
| Mycobacterium avium complex |
CD4 <50 mm3 |
Azithromycin 1200 mg po qw |
Rifabutin 300 mg po qd |
Some providers may prefer to defer prophylaxis until after the first trimester, because of general concerns about administering drugs in early pregnancy. Experience with rifabutin in pregnancy is limited.
Criteria for stopping primary prophylaxis: CD4 > 100/mm3 for 3 mo. |