for example [1:<6 years of age: Initiate primary PCP prophylaxis if CD4 + T-cell count> <500/mm 3 or CD4 + percentage> <15%. 156 HIV-infected children 6 12 years of age: Initiate primary PCP prophylaxis if CD4 + T-cell count> <200/mm 3 or CD4 + percentage> <15%. 156 Consider discontinuing primary PCP prophylaxis in HIV-infected children 1 to> <6 years of age who have received 6 months of antiretroviral therapy and have CD4 + T-cell counts that have remained 500/mm 3 or CD4 + percentages that have remained 15% for> 3 months. 156 Assess CD4 + T-cell count and CD4 + percentage every 3 months; reinitiate if indicated based on age-specific thresholds. 156 Consider discontinuing primary PCP prophylaxis in HIV-infected children 6 12 years of age who have received 6 months of antiretroviral therapy and have CD4 + T-cell counts that have remained 200/mm 3 or CD4 + percentages that have remained 15% for >3 months. 156 Assess CD4 + T-cell count and CD4 + percentage every 3 months; reinitiate if indicated based on age-specific thresholds. 156 Criteria for initiating or discontinuing primary PCP prophylaxis in HIV-infected adolescents are the same as those recommended for adults. 155 (See Adult Dosage under Dosage and Administration.) Prevention of Recurrence (Secondary Prophylaxis) of PCP Oral Infants 1 3 months of age : 30 40 mg/kg once daily. 134 156 Infants and children 4 24 months of age : 45 mg/kg once daily. 134 156 Children >24 months to 12 years of age : 30 40 mg/kg once daily. 134 156 Adolescents 13 years of age: 1.5 g once daily. 1 134 155 156 Alternatively, 1.5 g once daily in conjunction with oral pyrimethamine (25 mg once daily) and oral leucovorin (10 mg once daily). 155 Initiate secondary PCP prophylaxis in all HIV-infected infants and children with a history of PCP. 156 Consider discontinuing secondary PCP prophylaxis in HIV-infected children 1 to <6 years of age who have received 6 months of antiretroviral therapy and have CD4 + T-cell counts that have remained 500/mm 3 or CD4 + percentages that have remained 15% for> 3 months. 156 Assess CD4 + T-cell count and CD4 + percentage every 3 months; reinitiate if indicated based on age-specific thresholds. 156 Consider discontinuing secondary PCP prophylaxis in HIV-infected children 6 12 years of age who have received 6 months of antiretroviral therapy and have CD4 + T-cell counts that have remained 200/mm 3 or CD4 + percentages that have remained 15% for >3 months. 156 Assess CD4 + T-cell count and CD4 + percentage every 3 months; reinitiate if indicated based on age-specific thresholds. 156 Criteria for initiating or discontinuing secondary PCP prophylaxis in HIV-infected adolescents are the same as those recommended for adults. 155 (See Adult Dosage under Dosage and Administration.) Toxoplasmosis Treatment of Toxoplasmosis Oral Adolescents: 1.5 g twice daily in conjunction with oral pyrimethamine (200-mg loading dose, then 50 mg once daily in those weighing <60 kg or 75 mg once daily in those weighing 60 kg) and oral leucovorin (10 25 mg once daily, may be increased to 50 mg once or twice daily). 155 Alternatively, 1.5 g twice daily in conjunction with oral sulfadiazine (1 g every 6 hours in those weighing> <60 kg or 1.5 g every 6 hours in those weighing 60 kg). 155 Alternatively, 1.5 g twice daily alone. 155 Treatment duration at least 6 weeks; longer duration may be appropriate if clinical or radiologic disease is extensive or response incomplete at 6 weeks. 155 Prevention of Initial Episode (Primary Prophylaxis) of Toxoplasmosis Oral Infants 1 3 months of age : 30 mg/kg once daily. 156 Infants and children 4 24 months of age : 45 mg/kg once daily. 156 Alternatively, 45 mg/kg once daily in conjunction with oral pyrimethamine (1 mg/kg or 15 mg/m 2 [up to 25 mg] once daily) and oral leucovorin (5 mg once every 3 days). 156 Children> 24 months of age : 30 mg/kg once daily. 156 Adolescents: 1.5 g once daily. 155 Alternatively, 1.5 g once daily in conjunction with pyrimethamine (25 mg once daily) and oral leucovorin (10 mg once daily). 155 HIV-infected children seropositive for T. gondii : Initiate primary toxoplasmosis prophylaxis in those <6 years of age if CD4 + T-cell percentage> <15% and in those 6 years of age if CD4 + T-cell count> <100/mm 3 . 156 Consider discontinuing primary toxoplasmosis prophylaxis in HIV-infected children 1 to> <6 years of age who have received 6 months of antiretroviral therapy and have CD4 + T-cell percentages that have remained 15% for> 3 months. 156 Reinitiate if CD4 + T-cell percentage decreases to <15%. 156 Consider discontinuing primary toxoplasmosis prophylaxis in HIV-infected children 6 years of age who have received 6 months of antiretroviral therapy and have CD4 + T-cell counts that have remained> 200/mm 3 for >3 months. 156 Reinitiate if CD4 + T-cell count decreases to <100 200/mm 3 . 156 Criteria for initiating or discontinuing primary toxoplasmosis prophylaxis in HIV-infected adolescents are the same as those recommended for adults. 155 (See Adult Dosage under Dosage and Administration.) Prevention of Recurrence (Secondary Prophylaxis) of Toxoplasmosis Oral Infants 1 3 months of age : 30 mg/kg once daily. 156 Infants and children 4 24 months of age : 45 mg/kg once daily. 156 Alternatively, 45 mg/kg once daily in conjunction with oral pyrimethamine (1 mg/kg or 15 mg/m 2 [up to 25 mg] once daily) and oral leucovorin (5 mg once every 3 days). 156 Children> 24 months of age : 30 mg/kg once daily. 156 Adolescents: 750 1500 mg twice daily in conjunction with oral pyrimethamine (25 mg once daily) and oral leucovorin (10 mg once daily). 155 Alternatively, 750 1500 mg twice daily in conjunction with oral sulfadiazine (2 4 g daily in 2 4 divided doses). 155 Alternatively, 750 1500 mg twice daily used alone. 155 Initiate secondary toxoplasmosis prophylaxis in all HIV-infected infants and children who have been treated for T. gondii encephalitis. 156 Consider discontinuing secondary toxoplasmosis prophylaxis in HIV-infected children 1 to <6 years of age who completed toxoplasmosis treatment, are asymptomatic with respect to toxoplasmic encephalitis, have received 6 months of antiretroviral therapy, and have CD4 + T-cell percentages that have remained 15% for> 6 consecutive months. 156 Reinitiate if CD4 + T-cell percentage decreases to <15%. 156 Consider discontinuing secondary toxoplasmosis prophylaxis in HIV-infected children 6 years of age who completed toxoplasmosis treatment, are asymptomatic with respect to toxoplasmic encephalitis, have received 6 months of antiretroviral therapy, and have CD4 + T-cell counts that have remained> 200/mm 3 for >6 consecutive months. 156 Reinitiate if CD4 + T-cell count decreases to <200/mm 3 . 156 Criteria for initiating or discontinuing secondary toxoplasmosis prophylaxis in HIV-infected adolescents are the same as those recommended for adults. 155 (See Adult Dosage under Dosage and Administration.) Babesiosis Oral 20 mg/kg (up to 750 mg) twice daily for 7 10 days recommended by IDSA and others; 134 178 used in conjunction with oral azithromycin (10 mg/kg [up to 500 mg] once on day 1, then 5 mg/kg [up to 250 mg] once daily for total of 7 10 days). 134 178 Adults Pneumocystis jirovecii Pneumonia Treatment of Mild to Moderate PCP Oral 750 mg twice daily for 21 days. 1 134 155 Prevention of Initial Episode (Primary Prophylaxis) of PCP Oral 1.5 g once daily. 1 134 155 Alternatively, 1.5 g once daily in conjunction with oral pyrimethamine (25 mg once daily) and oral leucovorin (10 mg once daily). 155 Initiate primary PCP prophylaxis in HIV-infected adults with CD4 + T-cell counts> <200/mm 3 or a history of oropharyngeal candidiasis. 155 Also consider primary PCP prophylaxis if CD4 + T-cell percentage> <14% or there is a history of an AIDS-defining illness. 155 Also consider in those with CD4 + T-cell counts> 200/mm 3 but <250/mm 3 if frequent monitoring (e.g., every 3 months) not possible. 155 Discontinue primary PCP prophylaxis in HIV-infected adults responding to antiretroviral therapy who have CD4 + T-cell counts that have remained> 200/mm 3 for >3 months. 155 Reinitiate primary PCP prophylaxis if CD4 + T-cell count decreases to <200/mm 3 . 155 Prevention of Recurrence (Secondary Prophylaxis) of PCP Oral 1.5 g once daily. 1 134 155 Alternatively, 1.5 g once daily in conjunction with oral pyrimethamine (25 mg once daily) and oral leucovorin (10 mg once daily). 155 Initiate secondary PCP prophylaxis in all HIV-infected adults with a history of PCP. 155 Consider discontinuing secondary PCP prophylaxis in HIV-infected adults who have responded to antiretroviral therapy and have CD4 + T-cell counts that have remained> 200/mm 3 for >3 months. 155 Reinitiate if CD4 + T-cell count decreases to <200/mm 3 or PCP recurs when CD4 + T-cell count> 200/mm 3 . 155 Consider continuing secondary PCP prophylaxis for life (regardless of CD4 + T-cell count) if PCP occurred or recurred when CD4 + T-cell count >200/mm 3 . 155 Toxoplasmosis Treatment of Toxoplasmosis Oral 1.5 g twice daily in conjunction with oral pyrimethamine (200-mg loading dose, then 50 mg once daily in those weighing <60 kg or 75 mg once daily in those weighing 60 kg) and oral leucovorin (10 25 mg once daily, may be increased to 50 mg once or twice daily). 155 Alternatively, 1.5 g twice daily in conjunction with oral sulfadiazine (1 g every 6 hours in those weighing> <60 kg or 1.5 g every 6 hours in those weighing 60 kg). 155 Alternatively, 1.5 g twice daily alone. 155 Treatment duration at least 6 weeks; longer duration may be appropriate if clinical or radiologic disease is extensive or response incomplete at 6 weeks. 155 Prevention of Initial Episode (Primary Prophylaxis) of Toxoplasmosis Oral 1.5 g once daily. 155 Alternatively, 1.5 g once daily in conjunction with pyrimethamine (25 mg once daily) and oral leucovorin (10 mg once daily). 155 Initiate primary toxoplasmosis prophylaxis in all HIV-infected adults seropositive for Toxoplasma IgG antibody who have CD4 + T-cell counts> <100/mm 3 . 155 Discontinue primary toxoplasmosis prophylaxis in HIV-infected adults responding to antiretroviral therapy who have CD4 + T-cell counts that have remained> 200/mm 3 for >3 months. 155 Reinitiate primary toxoplasmosis prophylaxis if CD4 + T-cell count decreases to <100 200/mm 3 . 155 Prevention of Recurrence (Secondary Prophylaxis) of Toxoplasmosis Oral 750 1500 mg twice daily in conjunction with oral pyrimethamine (25 mg once daily) and oral leucovorin (10 mg once daily). 155 Alternatively, 750 1500 mg twice daily in conjunction with oral sulfadiazine (2 4 g daily in 2 4 divided doses). 155 Alternatively, 750 1500 mg twice daily alone. 155 Initiate secondary toxoplasmosis prophylaxis in all HIV-infected adults who have been treated for T. gondii encephalitis. 155 Consider discontinuing secondary toxoplasmosis prophylaxis in adults who completed toxoplasmosis treatment, are asymptomatic with respect to toxoplasmic encephalitis,and have responded to antiretroviral therapy with CD4 + T-cell counts that have remained> 200/mm 3 for >6 months. 155 Reinitiate secondary toxoplasmosis prophylaxis if CD4 + T-cell count decreases to <200/mm 3 . 155 Babesiosis Oral 750 mg twice daily for 7 10 days recommended by IDSA and others; 134 178 used in conjunction with oral azithromycin (0.5 1 g on day 1, then 250 mg once daily for total of 7 10 days; 0.6 1 g daily in immunocompromised patients). 178 Prescribing Limits Pediatric Patients Babesiosis Oral Maximum 750 mg twice daily. 178 Special Populations No special population dosage recommendation at this time. 1 Cautions for Atovaquone Contraindications Hypersensitivity to atovaquone or any ingredient in the formulation. 1 Warnings/Precautions Warnings Precautions Related to PCP Clinical experience with atovaquone for treatment of PCP limited to patients with mild to moderate infections. 1 Treatment of more severe episodes and efficacy following failure of co-trimoxazole treatment not systematically studied. 1 Not effective therapy for concurrent pulmonary conditions such as bacterial, viral, or fungal pneumonia or mycobacterial diseases. 1 Clinical deterioration during atovaquone treatment could represent secondary infection with nonsusceptible pathogen and/or progression of PCP. 1 Evaluate all patients with acute PCP for other possible causes of pulmonary disease and treat with additional agents as appropriate. 1 General Precautions Administration Precautions Must be administered with food to enhance GI absorption of the drug and provide adequate plasma concentrations. 1 Plasma atovaquone concentrations correlate with treatment response and survival. 1 Consider alternative in patients unable to take atovaquone with food. 1 Use with caution in patients with GI disorders that may impair absorption (e.g., chronic diarrhea, malabsorption syndrome). 1 Specific Populations Pregnancy Category C. 1 Lactation Distributed into milk in rats; not known whether distributed into human milk. 1 Caution advised. 1 Pediatric Use Safety and efficacy not established in children. 1 Geriatric Use Insufficient experience in patients 65 years of age to determine if they respond differently than younger adults; clinical experience has not identified differences. 1 Select dosage with caution because of possible age-related decreases in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy. 1 Hepatic Impairment Use caution and close monitoring in patients with severe hepatic impairment. 1 Common Adverse Effects Rash, diarrhea, nausea, headache, vomiting, fever, asthenia. 1 Interactions for Atovaquone Protein-bound Drugs Highly bound to plasma proteins; use with caution in patients receiving highly protein-bound drugs with narrow therapeutic indices since competition for binding sites may occur. 1 Specific Drugs Drug Interaction Comments Antimycobacterials, rifamycins Rifampin: Decreased atovaquone concentrations and half-life; increased rifampin concentrations 1 Rifabutin: Specific studies not available; pharmacokinetic interactions similar to those reported with rifampin may occur 1 Rifampin: Concomitant use not recommended 1 Co-trimoxazole Slightly decreased concentrations of trimethoprim and sulfamethoxazole; no clinically important effect on atovaquone concentrations 1 Metoclopramide Decreased bioavailability of atovaquone reported with the fixed combination of atovaquone and proguanil hydrochloride (atovaquone/proguanil) 41 Use concomitantly only if other antiemetics not available 41 Phenytoin No effect on protein binding of either drug 1 Tetracycline Decreased atovaquone concentrations reported with atovaquone/proguanil 41 Zidovudine Increased zidovudine AUC; no change in atovaquone pharmacokinetics 1 Not considered clinically important Atovaquone Pharmacokinetics Absorption Bioavailability Following oral administration, bioavailability highly dependent on formulation and diet. 1 Bioavailability of oral suspension in fasting or fed state is about twice that of previously available tablet formulation. 1 In HIV-infected adults, absolute bioavailability is approximately 47% when 750-mg dose given as the oral suspension under fed conditions compared with approximately 23% when dose given as previously available tablets. 1 Food Food increases absorption approximately twofold; 1 should be taken with food to ensure adequate plasma concentrations. 1 In HIV-infected adults receiving 500 mg as the oral suspension, peak plasma concentrations were 15.1 mcg/mL when administered with food (400 kcal, 23 g fat) compared with 8.8. mcg/mL when given in fasting state. 1 Special Populations Absorption may be limited in patients with GI disorders. 1 Distribution Plasma Protein Binding Extensively bound to plasma proteins (99.9%). 1 Crosses placenta in animals. 1 Distributed into milk in rats in concentrations approximately 30% of concurrent maternal plasma concentrations. 1 Not known whether distributed into human milk. 1 Elimination Metabolism Minimally metabolized; no metabolite identified. 1 Elimination Route Enterohepatic recirculation and eventual elimination in feces; 1> 94% of dose excreted unchanged in feces over 21 days. 1 Minimal excretion in urine ( <0.6%). 1 Half-life 67 78 hours. 1 Special Populations Hepatic impairment: Studies using atovaquone/proguanil indicate no marked differences in rate or extent of systemic exposure to atovaquone in patients with mild to moderate hepatic impairment, but atovaquone elimination half-life prolonged in those with moderate hepatic impairment. 41 Renal impairment: Studies using atovaquone/proguanil indicate atovaquone clearance in patients with mild to moderate renal impairment similar to that in those with normal renal function, 41 but atovaquone plasma concentrations and AUC decreased in those with severe renal impairment (Cl cr> <30 mL/minute). 41 Stability Storage Oral Suspension 15 25 C. Do not freeze. 1 Actions and Spectrum Synthetic hydroxynaphthoquinone-derivative antiprotozoal agent. 1 7 8 10 15 17 Selectively inhibits mitochondrial electron transport with consequent inhibition of de novo pyrimidine synthesis. 3 5 7 8 10 11 12 13 15 17 24 Active in vitro and/or in vivo against a variety of protozoa, 3 5 11 12 14 15 16 17 including Toxoplasma gondii 11 15 and Plasmodium . 14 15 41 Also active against the fungus Pneumocystis jirovecii (formerly Pneumocystis carinii ); 3 5 7 12 15 16 17 mechanism of action against P. jirovecii not fully elucidated. 1 Although clinical importance unknown, P. jirovecii with amino acid substitutions in cytochrome b (a likely target for atovaquone) have been obtained from several patients who developed PCP after receiving atovaquone prophylaxis. 1 Advice to Patients Importance of taking atovaquone concomitantly with food. 1 Advise patients using the multiple-dose bottle of oral suspension to shake it gently before removing a dose. 1 Advise those using single-dose foil pouch of oral suspension to ingest entire contents by mouth by discharging the dose into a dosing spoon or cup or directly into the mouth. 1 Importance of completing full course of therapy, even if feeling better after a few days. 1 Importance of recognizing pulmonary manifestations of possibly concurrent bacterial, viral, fungal, or mycobacterial infections associated with HIV infection and/or progression of the underlying PCP and contacting a clinician if pulmonary symptomatology develops or worsens during atovaquone therapy. 1 20 Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs. 1 Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed. 1 Importance of informing patients of other important precautionary information. 1 (See Cautions.) Preparations Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details. Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations. * available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name Atovaquone Routes Dosage Forms Strengths Brand Names Manufacturer Oral Suspension 750 mg/5 mL* Atovaquone Suspension Mepron GlaxoSmithKline AHFS DI Essentials. Copyright 2017, Selected Revisions August 29, 2014. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814. Use is not currently included in the labeling approved by the US Food and Drug Administration. References 1. GlaxoSmithKline. Mepron (atovaquone) oral suspension prescribing information. Research Triangle Park, NC; 2013 Mar. 2. Nightingale SL. From the Food and Drug Administration. JAMA . 1992; 267:339. [PubMed 1727943] 3. Falloon J, Kovacs J, Hughes W et al. A preliminary evaluation of 566C80 for the treatment of pneumocystis pneumonia in patients with the acquired immunodeficiency syndrome. New Engl J Med . 1991; 325:1534-8. [PubMed 1944437] 4. Hughes WT. A new drug (566C80) for the treatment of pneumocystis carinii pneumonia. Ann Intern Med . 1992; 116:953-4. [PubMed 1580456] 5. Hughes WT, Kennedy W, Shenep JL et al. Safety and pharmacokinetics of 566C80, a hydroxynaphthoquinone with anti-pneumocystis carinii activity: a phase I study in human immunodeficiency virus (HIV)-infected men. J Infect Dis . 1991; 163:843-8. [PubMed 2010637] 6. Anon. FDA authorizes wider use of new oral medication for AIDS. Oncology . 1991; 5:59. 7. Dohn MN, Frame PT, Baughman RP et al. Open-label efficacy and safety trial of 42 days of 566C80 for Pneumocystis carinii pneumonia in AIDS patients. J Protozool . 1991; 38:220-1S. 8. Hudson AT, Randall AW, Fry M et al. Novel anti-malarial hydroxynaphthoquinones with potent broad spectrum anti-protozoal activity. Parasitology . 1985; 90:45-55. [PubMed 3920634] 9. Wong RJ. Highlights of the Seventh International Conference on AIDS. Clin Pharm . 1991; 10:809-22. [PubMed 1686580] 10. Gutteridge WE. Antimalarial drugs currently in development. J R Soc Med . 1989; 17:63-6. 11. Araujo FG, Huskinson J, Remington JS. Remarkable in vitro and in vivo activities of the hydroxynaphthoquinone 566C80 against tachyzoites and tissue cysts of Toxoplasma gondii . Antimicrob Agents Chemother . 1991; 35: 293-9. 12. Hughes WT, Gray VL, Gutteridge WE et al. Efficacy of a hydroxynaphthoquinone, 566C80, in experimental Pneumocystis carinii pneumonitis. Antimicrob Agents Chemother . 1990; 34:225-8. [PubMed 2327770] 13. Hammond DJ, Burchell JR, Pudney M. Inhibition of pyrimidine biosynthesis de novo in Plasmodium falciparum by 2-(4-t-butylcyclohexyl)-3-hydroxy-1, 4-naphthoquinone in vitro. Mol Biochem Parasitol . 1985; 14:97-109. [PubMed 3885032] 14. Davies CS, Pudney M, Matthews PJ et al. The causal prophylactic activity of the novel hydroxynaphthoquinone 566C80 against Plasmodium berghei infections in rats. Acta Leiden . 1989; 58:115-28. [PubMed 2489391] 15. Burroughs Wellcome, Research Triangle Park, NC: Personal communication. 16. Sattler FR, Feinberg J. New developments in the treatment of Pneumocystis carinii pneumonia. Chest . 1992; 101:451-7. [PubMed 1531191] 17. Gutteridge WE. 566C80, an antimalarial hydroxynaphthoquinone with broad spectrum: experimental activity against opportunistic parasitic infections of AIDS patients. J Protozool . 1991; 38:141-3S. 18. Fry M, Pudney M. Site of action of the antimalarial hydroxynaphthoquinone, 2-[ trans -4-(4 -chlorophenyl) cyclohexyl]-3-hydroxy-1,4-naphthoquinone (566C80). Biochem Pharmacol . 1992; 43:1545-53. [PubMed 1314606] 20. Burroughs Wellcome. Formulary information: new Mepron atovaquone 250 mg tablets. Research Triangle Park, NC; 1992 Nov. 21. Murray JF, Felton CP, Garay SM et al. Pulmonary complications of the acquired immunodeficiency syndrome. Report of a National Heart, Lung, and Blood Institute Workshop. N Engl J Med . 1984; 310:1682-8. [PubMed 6328301] 22. Food and Drug Administration. List of orphan designations and approvals. From FDA web site. 23. Anon. New oral agent for PCP is effective, well tolerated. Oncology . 1992; 6:88. [PubMed 1449979] 24. Hughes W, Leoung G, Kramer F et al. Comparison of atovaquone (566C80) with trimethoprim-sulfamethoxazole to treat Pneumocystis carinii pneumonia in patients with AIDS. N Engl J Med . 1993; 328:1521-7. [PubMed 8479489] 26. Dohn MN, Weinberg WG, Torres RA et al. Oral atovaquone compared with intravenous pentamidine for Pneumocystis carinii pneumonia in patients with AIDS. Ann Intern Med . 1994; 121:174-80. [PubMed 7880228] 27. Kovacs JA and the NIAID-Clinical Center Intramural AIDS Program. Efficacy of atovaquone in treatment of toxoplasmosis in patients with AIDS. Lancet . 1992; 340:637-8. [PubMed 1355212] 28. Hughes W, Leoung G, Kramer F et al. Comparison of 566C80 & trimethoprim-sulfamethoxazole (TMP-SMZ) for the treatment of P. carinii pneumonitis (PCP). Int Conf AIDS 1992. Abstract No. WeB 1019. 30. Pagano G, Kennedy W, Weller S et al. The safety and pharmacokinetics of atovaquone in immunocompromised children. In: Program and Abstracts of the IXth International Conference on AIDS. Berlin, Germany; 1993 June 6-11:378. Abstract No. PO-B10-1455. 31. Lee BL, Tauber MG, Sadler B et al. Atovaquone inhibits the glucuronidation and increases the serum concentrations of zidovudine (ZDV). Proceedings of ICAAC Orlando 1994. Abstract No. A46. 32. LaFon S, Masur H, Sattler F et al. The relationship of treatment-limiting adverse events (TLAE) to time on therapy and plasma drug concentrations in a randomized trial of trimethoprim/sulfamethoxazole (T/S) vs. atovaquone (ATQ) for the therapy of AIDS related Pneumocystis pneumonia (PCP). In: Program and Abstracts of the IXth International Conference on AIDS. Berlin, Germany; 1993 June 6-11:377. Abstract No. PO-B10-1454. 33. El-Sadr WM, Murphy RS, Yurik TM et al. Atovaquone compared with dapsone for the prevention of Pneumocystis carinii pneumonia in patients with HIV infection who cannot tolerate trimethoprim, sulfonamides, or both. N Engl J Med . 1998; 339:1889-95. [PubMed 9862944] 34. Fishman JA. Treatment of infection due to Pneumocystis carinii . Antimicrob Agents Chemother . 1998; 42:1309-14. [PubMed 9624465] 35. Weverling GJ, Mocroft A, Ledergerber B et al. Discontinuation of Pneumocystis carinii pneumonia prophylaxis after start of highly active antiretroviral therapy in HIV-1 infection: EuroSIDA study group. Lancet . 1999; 353:1293-8. [PubMed 10218526] 36. Schneider MME, Borleffs JCC, Stolk RP et al. Discontinuation of prophylaxis for Pneumocystis carinii pneumonia in HIV-1 infected patients treated with highly active antiretroviral therapy. Lancet . 1999;353:201-3. 37. Furrer H, Egger M, Opravil M et al. Discontinuation of primary prophylaxis against Pneumocystis carinii pneumonia in HIV-1 infected adults treated with combination antiretroviral therapy. N Engl J Med . 1999; 340:1301-6. [PubMed 10219064] 38. Chan C, Montaner J, Lefebvre EA et al. Atovaquone suspension compared with aerosolized pentamidine for prevention of Pneumocystis carinii pneumonia in human immunodeficiency virus-infected subjects intolerant of trimethoprim or sulfomamides. J Infect Dis . 1999; 180:369-76. [PubMed 10395851] 39. Katlama C, Mouthon B, Gourdon D et al. Atovaquone as long-term suppressive therapy for toxoplasmic encephalitis in patients with AIDS and multiple drug intolerance: atovaquone expanded access group. AIDS . 1996; 10:1107-12. [PubMed 8874627] 41. GlaxoSmithKline. Malarone (atovaquone and proguanil hydrochloride) tablets and pediatric tablets prescribing information. Research Triangle Park, NC; 2013 Jun. 42. Pearson PA, Piracha AR, Sen HA et al. Atovaquone for the treatment of toxoplasma retinochoroiditis in immunocompetent patients. Ophthalmology . 1999; 106:148-53. [PubMed 9917796] 43. Torres RA, Weinberg W, Stansell J et al. Atovaquone for salvage treatment and suppression of toxoplasmic encephalitis in patients with AIDS. Atovaquone/Toxoplasmic Encephalitis Study Group. Clin Infect Dis . 1997; 24:422-9. [PubMed 9114194] 44. Looareesuwan S, Chulay JD, Canfield CJ et al. Malarone (atovaquone and proguanil hydrochloride): a review of its clinical development for treatment of malaria. Malarone Clinical Trials Study Group. Am J Trop Med Hyg . 1999; 60:533-41. [PubMed 10348225] 45. Looareesuwan S, Viravan C, Webster HK et al. Clinical studies of atovaquone, alone or in combination with other antimalarial drugs, for treatment of acute uncomplicated malaria in Thailand. Am J Trop Med Hyg . 1996; 54:62-6. [PubMed 8651372] 46. Dworkin MS, Hanson DL, Kaplan JE et al. Risk for preventable opportunistic infections in persons with AIDS after antiretroviral therapy increases CD4+ T lymphocyte counts above prophylaxis thresholds. J Infect Dis . 2000; 182:611-5. [PubMed 10915098] 47. Mussini C, Pezzotto P, Govoni A et al. Discontinuation of primary prophylaxis for Pneumocystis carinii pneumonia and toxoplasmic encephalitis in human immunodeficient virus type 1-infected patients: the changes in opportunistic prophylaxis study. J Infect Dis . 2000; 181:1635-42. [PubMed 10823763] 48. Lopez Bernaldo de Quiros JC, Miro JM, Pena JM et al. A randomized trial of the discontinuation of primary and secondary prophylaxis against Pneumocystis carinii pneumonia after highly active antiretroviral therapy in patients with HIV infection: Grupo de Estudio del SIDA 04/98. N Engl J Med . 2001; 344:159-67. [PubMed 11172138] 49. Furrer H, Opravil M, Rossi M et al. Discontinuation of primary prophylaxis in HIV-infected patients at high risk of Pneumocystis carinii pneumonia: prospective multicentre study. AIDS . 2001; 15:501-7. [PubMed 11242147] 50. Kirk O, Lundgren JD, Pedersen C et al. Can chemoprophylaxis against opportunistic infections be discontinued after an increase in CD4 cells induced by highly active antiretroviral therapy? AIDS . 1999; 13:1647-51. 51. Soriano V, Dona C, Rodriguez-Rosado R et al. Discontinuation of secondary prophylaxis for opportunistic infections in HIV-infected patients receiving highly active antiretroviral therapy. AIDS . 2000; 14:383-6. [PubMed 10770540] 52. Ledergerber B, Mocroft A, Reiss P et al. Discontinuation of secondary prophylaxis against Pneumocystis carinii pneumonia in patients with HIV infection who have a response to antiretroviral therapy. N Engl J Med . 2001; 344:168-74. [PubMed 11188837] 53. Furrer H, Opravil M. Bernasconi E et al. Stopping primary prophylaxis in HIV-1-infected patients at high risk of toxoplasma encephalitis: Swiss HIV cohort study. Lancet . 2000; 355:2217-8. [PubMed 10881897] 105. American Academy of Pediatrics. Red Book: 2012 Report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2012. 134. Anon. Drugs for parasitic infections. Treat Guidel Med Lett . 2010; 8:e1-16. 155. Panel on Opportunistic Infections in HIV-infected Adults and Adolescents. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America (May 7, 2013). Updates may be available at HHS AIDS Information (AIDSinfo) website. 156. Panel on Opportunistic Infection in HIV-exposed and HIV-infected children, US Department of Health and Human Services (HHS). Guidelines for the prevention and treatment of opportunistic infections in HIV-exposed and HIV-infected children: recommendations from the National Institutes of Health, Centers for Disease Control and Prevention, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics (Nov 6, 2013). Updates may be available at HHS AIDS Information (AIDSinfo) website. 178. Wormser GP, Dattwyler RJ, Shapiro ED et al. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis . 2006; 43:1089-134. [PubMed 17029 that i wonder
high-quality Atovaquone workers
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