Cotrimoxazole Prophylaxis

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Click here to access the Primary Health Care - PHC Chapter 11: Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV and AIDS) - 26 February 2026

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Description

Medicine Treatment

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Z29.2 + (B24)

DESCRIPTION

Primary prophylaxis reduces the probability of developing many infections, e.g.:

• Pneumocystis pneumonia
• Bacteraemia
• Cystoisosporiasis
• Toxoplasmosis
• Bacterial pneumonia

Indications for primary prophylaxis:

• WHO Clinical stage 2, 3 or 4.
• CD4 count <200 cells/mm³.

LoE:IIIb²⁸

MEDICINE TREATMENT

Prophylaxis           

• Cotrimoxazole, oral, 160/800 mg daily

LoE:IIb²⁹

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Note:

- Once the CD4 >200 cells/mm³ discontinue prophylaxis. If the CD4 count was >200 cells/mm³ when cotrimoxazole was commenced (e.g. patients with TB) continue for 6 months (See: Pneumocystis pneumonia).
 - Cotrimoxazole hypersensitivity is common and usually presents as a maculopapular rash. If there are systemic features or mucosal involvement associated with the use of cotrimoxazole, stop the medicine immediately and permanently and refer the patient to hospital.

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LoE:IIb³⁰

Click here to access the pdf

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 2.1_09 December 2024

Chapter 11: Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV AND AIDS)_11.2 Opportunistic Infections, Prophylaxis in Adults_11.2.1 Cotrimoxazole Prophylaxis