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.
Publication types
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Research Support, Non-U.S. Gov't
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Research Support, U.S. Gov't, Non-P.H.S.
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Research Support, U.S. Gov't, P.H.S.
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Review
MeSH terms
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AIDS-Related Opportunistic Infections / complications
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AIDS-Related Opportunistic Infections / epidemiology
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AIDS-Related Opportunistic Infections / prevention & control*
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Africa / epidemiology
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Anti-Infective Agents / adverse effects
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Anti-Infective Agents / pharmacology
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Anti-Infective Agents / therapeutic use*
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Breast Feeding / adverse effects
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Chemoprevention
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Drug Resistance
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Humans
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Infant
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Infant, Newborn
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Pneumonia, Pneumocystis / etiology
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Pneumonia, Pneumocystis / prevention & control*
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Practice Guidelines as Topic
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Trimethoprim, Sulfamethoxazole Drug Combination / adverse effects
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Trimethoprim, Sulfamethoxazole Drug Combination / pharmacology
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Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use*
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World Health Organization
Substances
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Anti-Infective Agents
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Trimethoprim, Sulfamethoxazole Drug Combination