Cotrimoxazole preventive therapy (CPT)

Clinical description

• CPT prevents Pneumocystis pneumonia (PJP), diarrhoea, malaria and other HIV-related

diseases and prolongs survival.

• Start all the following on CPT:

o HIV exposed children from age 6 weeks o HIV infected children from age 6 weeks o HIV infected adults

• Stop CPT in HIV exposed children when confirmed negative when discharged from exposed

infant follow-up (following a negative HIV diagnostic test 6 weeks after stopping of breastfeeding).

• Provide CPT to all patients in HCC and ART follow-up.
• CPT is tolerated very well by most patients, can be taken at the same time with ART, TB

treatment and TPT.

• CPT is safe in pregnancy.
• Do not combine CPT with SP – HIV positive pregnant women only take CPT (and ART).
• Children from 30kg and adults take one 960mg tablet of Cotrimoxazole 24-hourly.
• Dispersible paediatric tablets (120mg) are used for children under 14kg. Dosing of paediatric

CPT and ART are both based on the same weight bands.

• CPT 960mg is usually available in blister-packs of 10 tablets – 3 strips are for a 30-day supply.
• Poor adherence to CPT is a warning sign for poor adherence to ART. Provide additional client-

centred support to address barriers to adherence.

• Monitor toxicity and adverse reactions, especially for long term cotrimoxazole prophylaxis. See

section 24 for pharmacovigilance reporting.

Eligibility for CPT

• All infants born to HIV infected mothers (without confirmed HIV infection) from age 6 weeks:

o Aim to start CPT straight after the infant has finished ARV prophylaxis.

o Note: start HIV-exposed infants on CPT even if they did not receive ARV prophylaxis.

o Keep the infant on CPT until s/he is confirmed HIV-negative and is discharged from HCC follow-up (around age 24 months).

Preventive services for HIV patients

• Confirmed HIV infected children from age 6 weeks and adults:

o No contra-indication against CPT in the first trimester of pregnancy.

o Do not give SP to HIV infected pregnant women on CPT.

o If SP has already been taken, wait for 14 days before starting CPT.

CPT contraindications

• Jaundice
• Renal failure
• Suspected allergy to any of the following sulphonamide drugs (skin rash, mucosal ulceration,

severe anaemia, leukopenia)

o Cotrimoxazole o Sulphadoxine / Pyrimethamine (SP)

CPT dosage and duration

• See Table 17 on page 70 for dosing.
• HIV exposed children: stop CPT when confirmed HIV negative at least 6 weeks after stopping of

breastfeeding.

• HIV infected children and adults: continue CPT for life unless there are severe side effects.
• Poor adherence to CPT will reduce the effectiveness of preventing HIV-related diseases, but it is

less risky than poor adherence to ART.

• If pill burden is a challenge, particularly in adolescents, prioritize ART over CPT.

CPT intolerance

• Actively screen for potential CPT toxicity at every visit.
• Stopping CPT due to intolerance is not common.
• Document all serious side effects on the yellow pharmacovigilance forms and submit to PMRA or

report using the MEDSAFE-360 USSD platform.