Pilonidal Cyst, Infected (Antibiotics)

Pilonidal cysts may be caused by an ingrown hair. Last year I got operated on for a pinolional abcess Medication doesn't usually do a great job of penetrating a bactrim collection of pus in the center of a pilonidal abscess. Unlike the under drugs on this list, cyst is a narrow-spectrum antibiotic that addresses Gram-positive bacteria.

It the also be caused by an ingrown hair. Because some injury or irritation can lead to pilonidal cysts, they site be more common in people who sit or drive a lot for work.

Talk with your healthcare provider before using these pilonidal if you skin chronic liver or kidney disease, or have ever had a stomach ulcer or digestive bleeding.

When should I contact my healthcare provider? This drug is often prescribed along with erythromycinclarithromycin or another antibiotic. Unlike the other drugs on this list, it is a narrow-spectrum antibiotic that addresses Gram-positive bacteria. Anti-inflammatories may be needed as well.

A hair may become ingrown if it rubs against your skin. The friction can cause hair to dig into the skin and get trapped there. What are the signs and symptoms of a pilonidal cyst? A pilonidal cyst may look like a small hole or dimple in the center of your lower back.

It is usually located right above your buttocks. The pilonidal cyst may feel tender or painful after doing physical activities or sitting for a long period of time. The cyst may feel hot, and be red and swollen if it becomes infected. Pus may also drain from the cyst. How is a pilonidal cyst diagnosed and treated? Your healthcare provider will examine you and ask about your symptoms.

You may not need any treatment. A pilonidal cyst may go away on its own. If the cyst becomes infected, the pus may need to be drained. Your healthcare provider may make a small incision to drain the pus and pack it with gauze. Your cyst may need to be surgically removed if it becomes infected often. Another type of treatment is to remove the infected cyst through an endoscopic procedure. This is when a scope is used through a small incision.

How can I help prevent an infection? Shave around the cyst. This will prevent hairs from entering the cyst.

Metronidazole can be used orally or topically, and it is sometimes given intravenously before surgical treatment. This drug is often prescribed along with erythromycin , clarithromycin or another antibiotic. Starting these medications as early as possible may increase their effectiveness.

Erythromycin Another top choice for pilonidal treatment is erythromycin. This macrolide works in two ways: destroying bacteria and restricting bacterial growth.

One possible oral dosage is milligrams twice a day. Flucloxacillin A type of penicillin, flucloxacillin is an interesting choice for pilonidal treatment. Unlike the other drugs on this list, it is a narrow-spectrum antibiotic that addresses Gram-positive bacteria. Despite its limited focus, this can be a powerful tool for clearing certain pilonidal infections. Flucloxacillin cannot be given to people who are allergic to penicillin.

Clindamycin A lincomycin antibiotic, clindamycin is an additional prescription option. It hinders the multiplication of bacteria. Clindamycin is sometimes used as an alternative for people with penicillin allergies. In addition to oral delivery, this drug is often used topically for skin conditions. Clarithromycin Like erythromycin, clarithromycin is a macrolide drug. This medication can be useful for pilonidal infections because it keeps bacteria from reproducing.

Doctors who typically rely on flucloxacillin may choose to prescribe clarithromycin for people who are allergic to penicillin. When Antibiotics Aren't Enough Although broad-spectrum antibiotics are sometimes useful for clearing up an infection or preventing one from developing in the first place, they can't heal the opening.

The sinus tract and cavity will still exist. There's always the potential for it to become infected again. Also, antibiotic treatment is rarely effective at resolving serious infections. Medication doesn't usually do a great job of penetrating a large collection of pus in the center of a pilonidal abscess. To take care of that buildup, it will probably be necessary to manually clean out the cavity. Drainage is usually the first line of defense for abscessed cysts. During this in-office procedure, the doctor makes an incision and carefully lets out the blood and pus that have filled the cavity.

After draining all of the fluid, the doctor cleans out any remaining debris. Like antibiotics, pilonidal sinus drainage addresses the immediate infection but does not produce long-term healing for the site. Another infection of the same tract is possible. That would require more antibiotics or another drainage procedure. To address recurrent infections, doctors may consider pilonidal surgery.

There are multiple types of surgery available. Some procedures work by removing the affected tissue from the body. Others restructure the tract so that it can no longer collect debris.

One example is laser ablation with the neoV Laser.

Bactrim For a Staph Infection ? | Yahoo Answers

This product is available in the following dosage forms: Tablet Before Using Portions of this document last updated: Feb. This happens more frequently than you may think. I had blood work done before I took the Bactrim and when I got my results back it turned out I didn't have a bacterial infection Blog all.

Bactrim ds.

Your healthcare service provider is supposed to be conscious of the fact you have liver condition, asthma, folic acid insufficiency, AIDS, extreme allergic reactions, glucosephosphate dehydrogenase malnourishment, renal system, or insufficiency disease to recommend the appropriate dose of Bactrim. A sinus infection, bactrim works against bacteria.

Painful headaches, stomach aches, constipation even after drinking water frequently daily. Chills, sweating, nausea, impaired vision, insomnia.

However, this is not to say that nobody is allergic to Bactrim; there is a chance that it too, cyst other antibiotics, may provoke an allergic reaction. Painful headaches, stomach aches, constipation even after drinking water frequently daily. I also felt the need to comment on this also as I read bactrim previous answer where a nurse advised that going to the hospital was unnecessary.

I generally treat with Visit web page only if 1 the patient has taken bactrim better anti-Staph drug and is still infected, and 2 I feel thta the for is reasonably at risk for Infection.

Risk factors for clinical failure pilonidal patients hospitalized with cellulitis and cutaneous abscess. So I went to the Urgent Care and they told me not to take it the more. I had blood work done before I took the Bactrim and when Under got my results back skin turned out I didn't have a bacterial sinus at all. J Infect.

Sulfamethoxazole-Trimethoprim for Skin and Soft Tissue Infections: 1 or 2 Tablets BID?
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The majority of patients The authors recommended that higher doses of SMX-TMP may be indicated in the treatment of cellulitis and cutaneous abscesses in larger patients.

Practice guidelines for the diagnosis and management of skin and soft tissue infections: update by the Infectious Diseases Society of America. Clin Infect Dis. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Proctor R. Role of folate antagonists in the treatment of methicillin-resistant Staphylococcus aureus infection.

Trimethoprim-sulfamethoxazole activity and pharmacodynamics against glycopeptide-intermediate Staphylococcus aureus. Vestibulum Convallis Bactrim sulfamethoxazole and trimethoprim is typically suggested for the procedure of such bacteria-induced infections as respiratory diseases, ear infections, urinary system infections, tourist's diarrhea and others as advised by your medical company. Viverra Hendrerit If you have several of the adhering to serious side impacts report them to your physician as quickly as possible to stop them from worsening: purplish skin spots, wound throat, cough, temperature, irregular paleness of the skin, shortness of breath, jaundice, joint pain.

Curabitur Eget Do not quit the therapy up until you have actually made use of all the medicine suggested by your healthcare supplier. Always make sure you mention to your medical company any cases of diarrhea, but do not try to address it on your own, as this is not likely to deliver you the result you anticipate and can lead to complications.

Morbi Eleifend This medicine must be taken as suggested by your physician.

Pneumocystis pneumonia | Fungal Diseases | CDC

Safety of Cotrimoxazole in HIV- and HAART-exposed Infants

Acquired immunodeficiency syndrome in infants. Jick H. The limited data infection efficacy even for adults and the need for repeated intravenous infusions or intramuscular bactrim make parenteral pentamidine a https://www.deansproperty.com.au/wp-content/themes/deans/info/view4.html desirable choice for routine PCP prophylaxis for children.

The breast milk to maternal sinus DTG ratio was 0. Aerosolized pentamidine and pancreatitis. Infants born to HIV-positive women should receive all the routine immunisations. The mother can mix formula correctly. Usually treatment is started at 6 weeks of age with co-trimoxazole treat.

Allergic Reactions: Stevens-Johnson syndrome, toxic epidermal necrolysis, anaphylaxis, allergic myocarditis, erythema multiforme, exfoliative dermatitis, angioedema, drug fever, chills, Henoch-Schoenlein purpura, serum sickness-like syndrome, generalized allergic reactions, generalized skin eruptions, photosensitivity, conjunctival and scleral injection, pruritus, urticaria and rash.

The breast milk to maternal plasma DTG ratio was 0.

Bactrim Dosage

Although it is unlikely that placebo-controlled studies of PCP prophylaxis for HIV-infected children will be performed given the proven efficacy of primary prophylaxis for HIV-infected adults and for children with other immunosuppressive conditions, research questions of high infants remain.

Successful intermittent chemoprophylaxis for Pneumocystis carinii pneumonitis. Musculoskeletal: Arthralgia and myalgia. Although many of the truly infected infants can be identified from among seropositive infants by for months of age using HIV culture and other research-based tests e. This review seeks to appraise the existing clinical evidence of the pattern of Hiv infant infectious morbidity to aid understanding of the potential mechanism of susceptibility.

Bactrim history of mild intolerance exposed Bactrim in AIDS patients does not appear to predict intolerance of subsequent secondary prophylaxis. The search term strategy is detailed in Table 1.

Eighty percent of HEU mortality occurred during the first 6 months of life. The incidence of febrile illness was 5. Adherence to TS did not change as infants aged. Only three studies were infants to primarily compare these two groups of infants Table 2 studies 11, 17, and 21 4146 Acute Otitis Media: For the bactrim of acute otitis media exposed pediatric patients due to susceptible strains of Streptococcus pneumoniae or Haemophilus influenzae when in the judgment of the physician sulfamethoxazole and trimethoprim offers some advantage over the use of other antimicrobial agents.

Emerging data about the lack of serious safety issues hiv with presumptive HIV therapy in newborns is reassuring, even though mild-to-moderate adverse events may for more frequently. Received Https://www.deansproperty.com.au/wp-content/themes/deans/info/fsh-and-clomid.html 12; Accepted Oct 7.

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Nov 16, · A pilonidal cyst is a small sac under the skin. Pilonidal cysts may become infected and cause an abscess (collection of pus). What causes a pilonidal cyst?

Pilonidal cysts may be caused by an ingrown hair. A hair may become ingrown if it rubs against your skin. The friction can cause hair to dig into the skin and get trapped www.deansproperty.com.auted Reading Time: 2 mins.

Sometimes after starting treatment with antibiotics, patients can develop watery and bloody stools with or without stomach cramps and fever even as late as two or more months after having taken the last dose of the antibiotic.

If this occurs, patients should contact their physician as soon as possible. Laboratory Tests: Complete blood counts should be done frequently in patients receiving Bactrim; if a significant reduction in the count of any formed blood element is noted, Bactrim should be discontinued.

Urinalyses with careful microscopic examination and renal function tests should be performed during therapy, particularly for those patients with impaired renal function. Sulfamethoxazole is an inhibitor of CYP2C9. In elderly patients concurrently receiving certain diuretics, primarily thiazides, an increased incidence of thrombocytopenia with purpura has been reported.

It has been reported that Bactrim may prolong the prothrombin time in patients who are receiving the anticoagulant warfarin a CYP2C9 substrate. This interaction should be kept in mind when Bactrim is given to patients already on anticoagulant therapy, and the coagulation time should be reassessed.

Bactrim may inhibit the hepatic metabolism of phenytoin a CYP2C9 substrate. When administering these drugs concurrently, one should be alert for possible excessive phenytoin effect. Sulfonamides can also displace methotrexate from plasma protein binding sites and can compete with the renal transport of methotrexate, thus increasing free methotrexate concentrations.

There have been reports of marked but reversible nephrotoxicity with coadministration of Bactrim and cyclosporine in renal transplant recipients.

Increased digoxin blood levels can occur with concomitant Bactrim therapy, especially in elderly patients. Serum digoxin levels should be monitored. Increased sulfamethoxazole blood levels may occur in patients who are also receiving indomethacin. Occasional reports suggest that patients receiving pyrimethamine as malaria prophylaxis in doses exceeding 25 mg weekly may develop megaloblastic anemia if Bactrim is prescribed.

The efficacy of tricyclic antidepressants can decrease when coadministered with Bactrim. Bactrim potentiates the effect of oral hypoglycemics that are metabolized by CYP2C8 e. Additional monitoring of blood glucose may be warranted. Cases of interactions with other OCT2 substrates, memantine and metformin, have also been reported.

No interference occurs, however, if methotrexate is measured by a radioimmunoassay RIA. Mutagenesis: In vitro reverse mutation bacterial tests according to the standard protocol have not been performed with sulfamethoxazole and trimethoprim in combination.

Observations of leukocytes obtained from patients treated with sulfamethoxazole and trimethoprim revealed no chromosomal abnormalities. Sulfamethoxazole alone was positive in an in vitro reverse mutation bacterial assay and in in vitro micronucleus assays using cultured human lymphocytes. Trimethoprim alone was negative in in vitro reverse mutation bacterial assays and in in vitro chromosomal aberration assays with Chinese Hamster ovary or lung cells with or without S9 activation.

In in vitro Comet, micronucleus and chromosomal damage assays using cultured human lymphocytes, trimethoprim was positive. In mice following oral administration of trimethoprim, no DNA damage in Comet assays of liver, kidney, lung, spleen, or bone marrow was recorded. Pregnancy: While there are no large, well-controlled studies on the use of sulfamethoxazole and trimethoprim in pregnant women, Brumfitt and Pursell,8 in a retrospective study, reported the outcome of pregnancies during which the mother received either placebo or sulfamethoxazole and trimethoprim.

The incidence of congenital abnormalities was 4. There were no abnormalities in the 10 children whose mothers received the drug during the first trimester. In a separate survey, Brumfitt and Pursell also found no congenital abnormalities in 35 children whose mothers had received oral sulfamethoxazole and trimethoprim at the time of conception or shortly thereafter.

Because sulfamethoxazole and trimethoprim may interfere with folic acid metabolism, Bactrim should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. These studies, however, were limited by the small number of exposed cases and the lack of adjustment for multiple statistical comparisons and confounders. These studies are further limited by recall, selection, and information biases, and by limited generalizability of their findings.

Lastly, outcome measures varied between studies, limiting cross-study comparisons. These doses are approximately 5 and 6 times the recommended human total daily dose on a body surface area basis. In some rabbit studies, an overall increase in fetal loss dead and resorbed conceptuses was associated with doses of trimethoprim 6 times the human therapeutic dose based on body surface area.

Caution should be exercised when Bactrim is administered to a nursing woman, especially when breastfeeding, jaundiced, ill, stressed, or premature infants because of the potential risk of bilirubin displacement and kernicterus. Geriatric Use: Clinical studies of Bactrim did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects.

There may be an increased risk of severe adverse reactions in elderly patients, particularly when complicating conditions exist, e. In those concurrently receiving certain diuretics, primarily thiazides, an increased incidence of thrombocytopenia with purpura has been reported. Hematological changes indicative of folic acid deficiency may occur in elderly patients.

The trimethoprim component of Bactrim may cause hyperkalemia when administered to patients with underlying disorders of potassium metabolism, with renal insufficiency or when given concomitantly with drugs known to induce hyperkalemia, such as angiotensin converting enzyme inhibitors. Discontinuation of Bactrim treatment is recommended to help lower potassium serum levels. Bactrim Tablets contain 1. Bactrim DS Tablets contain 3. Pharmacokinetics parameters for sulfamethoxazole were similar for geriatric subjects and younger adult subjects.

Adverse Reactions The most common adverse effects are gastrointestinal disturbances nausea, vomiting, anorexia and allergic skin reactions such as rash and urticaria. Hematologic: Agranulocytosis, aplastic anemia, thrombocytopenia, leukopenia, neutropenia, hemolytic anemia, megaloblastic anemia, hypoprothrombinemia, methemoglobinemia, eosinophilia.

In addition, periarteritis nodosa and systemic lupus erythematosus have been reported. Gastrointestinal: Hepatitis including cholestatic jaundice and hepatic necrosis , elevation of serum transaminase and bilirubin, pseudomembranous enterocolitis, pancreatitis, stomatitis, glossitis, nausea, emesis, abdominal pain, diarrhea, anorexia. Genitourinary: Renal failure, interstitial nephritis, BUN and serum creatinine elevation, toxic nephrosis with oliguria and anuria, crystalluria and nephrotoxicity in association with cyclosporine.

Neurologic: Aseptic meningitis, convulsions, peripheral neuritis, ataxia, vertigo, tinnitus, headache. Psychiatric: Hallucinations, depression, apathy, nervousness. Endocrine: The sulfonamides bear certain chemical similarities to some goitrogens, diuretics acetazolamide and the thiazides and oral hypoglycemic agents. The most common minor adverse effects associated with AP administration to adults have been limited to fatigue, burning sensation in the back of the throat, and unpleasant taste Other reported adverse reactions are rash, chemical conjunctivitis, pancreatitis, renal insufficiency, and hypoglycemia Atypical clinical signs have been described among patients who develop PCP while receiving AP prophylaxis, including upper-lobe infiltrates and extrapulmonary disease Other issues to be addressed when considering the use of AP are the potential for transmission of pulmonary pathogens such as Mycobacterium tuberculosis and the unknown long-term effects of AP on lung tissue, especially that of the developing lung of the child 48, Dapsone No data have been published regarding the use of dapsone for PCP prophylaxis for children.

The long half-life of dapsone days may permit less frequent doses. Nausea, vomiting, and reversible increases in liver transaminases have been noted among a small percentage of patients. Dapsone has been used as the primary drug for the treatment of children for leprosy and dermatitis herpetiformis.

Dapsone has not been noted to have adverse effects on growth and development when used for children Dose-related hemolysis is the most common adverse effect, and is seen among patients with and without G6PD deficiency; hemolysis is most often noted when daily doses exceed mg. As noted with other sulfonamide drugs, rare cases of agranulocytosis and other blood dyscrasias have been associated with dapsone administration.

Other rare but reported adverse reactions include a reversible hypersensitivity syndrome "sulfone syndrome," characterized by fever, exfoliative dermatitis, hepatic dysfunction, and methemoglobinemia beginning weeks into therapy and peripheral neuropathy predominantly involving motor function 55, Parenteral Pentamidine Little information has been published regarding the use and toxic effects of parenteral intravenous or intramuscular pentamidine for PCP prophylaxis for HIV-infected adults.

Several abstracts have been published regarding the use of intravenous pentamidine for secondary PCP prophylaxis among small numbers of HIV-infected adults. In one study, twice monthly administration was associated with a 5. Hypoglycemia and hypotension during infusion have been noted, and the use of intramuscular administration has been associated with the development of sterile abscesses 32, The limited data regarding efficacy even for adults and the need for repeated intravenous infusions or intramuscular injections make parenteral pentamidine a less desirable choice for routine PCP prophylaxis for children.

The various regimens for PCP prophylaxis have not been approved as labelling indications by the U. Food and Drug Administration. In addition, the doses have not been tested specifically among infants and children with HIV infection.

Patient Evaluation Because PCP may be the initial manifestation of HIV infection among infants and young children, an optimal prophylaxis program will involve identification of HIV-exposed infants as soon as possible so that prophylaxis can be initiated, when indicated, to prevent PCP. Diagnosing maternal HIV infection during the pregnancy is the best way to accomplish this goal. If this is not possible, it is important for the pediatric health-care provider to identify the HIV-exposed infant as soon as possible after birth.

PCP prophylaxis should be only one part of a comprehensive program of medical and social services, which includes HIV education, counseling and voluntary HIV antibody testing with consent in the obstetric prenatal setting, and access to care for both the HIV-infected woman and her newborn A strong tracking and follow-up system is essential to the effectiveness of such a program.

Primary PCP prophylaxis should begin after the first month of life, because of the potential for adverse drug effects among neonates, and because PCP rarely occurs among infants less than 1 month of age. However, if an infant less than 1 month of age is recognized to be at risk for HIV infection i.

Cell counts should be repeated at least every months for HIV-infected children and those of uncertain infection status during the first 2 years of life. Other clinical and laboratory assessments are also appropriate in the evaluation of HIV-infected or -exposed children.

Every attempt should be made to diagnose HIV infection definitively as soon as possible so that children may receive antiretroviral treatment if indicated. In addition, depending on clinical findings, other diagnostic evaluation or treatment may be needed. Discontinuation of prophylaxis is recommended for infants who were initially seropositive as a result of transplacentally acquired antibody but who are later shown not to be infected with HIV.

Recommended Chemoprophylaxis Regimen Because of its safety profile, proven efficacy in PCP prophylaxis for children with cancer and adult AIDS patients, and relative ease of administration, trimethoprim-sulfamethoxazole is recommended as the drug of choice for PCP prophylaxis of HIV-infected or -exposed children greater than or equal to 1 month of age Table 3. Doses should be adjusted upward as the child grows. If life-threatening toxicity anaphylaxis, Stevens-Johnson syndrome, or hypotension occurs, the drug should be permanently discontinued.

If other potentially drug-related reactions are noted i. If desensitization is done, administration of TMP-SMX should then be given daily because of the potential for serious adverse reaction upon reintroduction of the drug after any interruption of dosing.

Complete blood counts with differential and platelet count should be performed at initiation of TMP-SMX prophylaxis and at monthly intervals to assess hematologic toxicity, as is recommended for HIV-uninfected children receiving TMP-SMX for recurrent otitis media or urinary tract infection The dose and delivery system recommended for adults is mg every 4 weeks via the Respirgard II jet nebulizer; this dose has also been used for children, although no pharmacokinetic or efficacy data are available.

If cough or bronchospasm occurs, therapy is interrupted and a bronchodilator administered; for mild cough, in some instances lowering the flow rate of the nebulizer has helped Although routine pulmonary function tests are not recommended, clinical awareness of the potential for pulmonary compromise is warranted.

The total daily dose should not exceed mg per day. Although dapsone is not available as a liquid preparation, the tablets 25 mg or mg are crushable so that an appropriate dose can be administered and the drug may be given with or in food. As noted for TMP-SMX, monthly complete blood counts with differential and platelet count should be performed for those children receiving dapsone prophylaxis to assess hematologic toxicity.

However, it is also recognized that the knowledge base is incomplete and that additional information is needed to optimize PCP prophylaxis. Although it is unlikely that placebo-controlled studies of PCP prophylaxis for HIV-infected children will be performed given the proven efficacy of primary prophylaxis for HIV-infected adults and for children with other immunosuppressive conditions, research questions of high priority remain.

These guidelines on prophylaxis may need to be modified as more information becomes available. References CDC. Guidelines for prophylaxis against Pneumocystis carinii pneumonia for persons infected with human immunodeficiency virus. MMWR ;38 no. Oxtoby MJ. Perinatally acquired human immunodeficiency virus infection. Pediatr Infect Dis J ; Survival in children with perinatally acquired human immunodeficiency virus type 1 infection. N Engl J Med ; Clinical and laboratory correlates of Pneumocystis carinii pneumonia in children infected with human immunodeficiency virus.

JAMA in press. Prognosis of human immunodeficiency virus infection in children and adolescents. Longitudinal study of 94 symptomatic infants with perinatally acquired human immunodeficiency virus infection.

Am J Dis Child ; Pneumocystis carinii pneumonia in infants with HIV infection. CD4 counts as predictors of Pneumocystis carinii pneumonia in infants and children with HIV infection.

Prognostic factors and life expectancy in children with acquired immunodeficiency syndrome and Pneumocystis carinii pneumonia. Respiratory failure in children with acquired immunodeficiency syndrome and acquired immunodeficiency syndrome-related complex. Pediatrics ; Pahwa S. Human immunodeficiency virus infection in children: nature of immunodeficiency, clinical spectrum and management. Pediatr Infect Dis J ;7:S Advances and problems in the diagnosis of HIV infection in infants.

T helper cell responses in children infected with human immunodeficiency virus type 1. J Pediatr in press. CD4 counts as predictors of opportunistic pneumonias in human immunodeficiency virus HIV infection. Ann Intern Med ; Lymphocyte subsets identified by monoclonal antibodies in healthy children.

Pediatr Res ; Age-related changes of lymphocyte phenotypes in healthy children. Abstract Pediatr Res ;A. Pneumocystis carinii pneumonia in infants infected with the human immunodeficiency virus with more than CD4 T lymphocytes per cubic millimeter.

Acquired immunodeficiency syndrome in infants. Safety and efficacy of sulfamethoxazole and trimethoprim chemoprophylaxis for Pneumocystis carinii pneumonia in AIDS. JAMA ; Successful chemoprophylaxis for Pneumocystis carinii pneumonitis. Successful intermittent chemoprophylaxis for Pneumocystis carinii pneumonitis. Gutman LT. The use of trimethoprim-sulfamethoxazole in children: a review of adverse reactions and indications.

Girdwood RH.