Pcp prophylaxis high dose steroids

The pharmacokinetics in the pediatric population with normal renal function of both components of Co-trimoxazole, trimethoprim and sulfamethoxazole are age dependent. Elimination of trimethoprim and sulfamethoxazole is reduced in neonates, during the first two months of life, thereafter both trimethoprim and sulfamethoxazole show a higher elimination with a higher body clearance and a shorter elimination half-life. The differences are most prominent in young infants (> months up to 24 months) and decrease with increasing age, as compared to young children (1 year up to years), children ( years and < 10 years) and adults (see section ).

Trimetrexate (Neutrexin) is a significantly more potent inhibitor of DHFR than trimethoprim (Proloprim), 18 so potent that hematopoietic cells must be protected through the coadministration of leucovorin. Although trimetrexate is significantly less toxic than trimethoprim-sulfamethoxazole, it is also less effective. 21 Because it is administered once daily, trimetrexate can be used in outpatients even though it is given intravenously. To mimic the sequential enzyme blockade provided by trimethoprim-sulfamethoxazole, dapsone (100 mg orally) can be added to the regimen.

Withhold Cotrimoxazole for at least 24 hours prior to the administration of intermediate or high dose Methotrexate infusions. Restart the Cotrimoxazole at least 72 hours after start of the Methotrexate infusion or the Methotrexate level is less than /L. If the child is a slow excretor of Methotrexate, restart Cotrimoxazole when Methotrexate levels are less than /L. What this means practically is that the oral cotrimoxazole will only be given to children receiving intermediate or high dose methotrexate when the child is at home.

TRUVADA should be avoided with concurrent or recent use of a nephrotoxic agent (., high-dose or multiple non-steroidal anti-inflammatory drugs [ NSAIDs ]) [see DRUG INTERACTIONS ]. Cases of acute renal failure after initiation of high-dose or multiple NSAIDs have been reported in HIV-infected patients with risk factors for renal dysfunction who appeared stable on tenofovir DF. Some patients required hospitalization and renal replacement therapy. Alternatives to NSAIDs should be considered, if needed, in patients at risk for renal dysfunction.

Pcp prophylaxis high dose steroids

pcp prophylaxis high dose steroids

TRUVADA should be avoided with concurrent or recent use of a nephrotoxic agent (., high-dose or multiple non-steroidal anti-inflammatory drugs [ NSAIDs ]) [see DRUG INTERACTIONS ]. Cases of acute renal failure after initiation of high-dose or multiple NSAIDs have been reported in HIV-infected patients with risk factors for renal dysfunction who appeared stable on tenofovir DF. Some patients required hospitalization and renal replacement therapy. Alternatives to NSAIDs should be considered, if needed, in patients at risk for renal dysfunction.

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