Preventive Regimen
Indication	First Choice	Alternative	Comments/Special Issues
Primary Prophylaxis	Clarithromycin 7.5 mg/kg body weight (maximum 500 mg) by mouth orally twice daily, or Azithromycin 20 mg/kg body weight (maximum 1200 mg) orally once weekly	Azithromycin 5 mg/kg body weight (maximum 250 mg) orally once daily Children aged >5 years: rifabutin 300 mg orally once daily with food	Primary Prophylaxis Indicated for Children: Aged <1 year with CD4 count <750 cells/mm3; Aged 1 to <2 years with CD4 count <500 cells/mm3; Aged 2 to <6 years with CD4 count <75 cells/mm3; Aged ≥6 years with CD4 count <50 cells/mm3 Criteria for Discontinuing Primary Prophylaxis: Do not discontinue in children age <2 years. After ≥6 months of cART and: Aged 2 to <6 years with CD4 count >200 cells/mm3for >3 consecutive months Aged ≥6 years with CD4 count >100 cells/mm3for >3 consecutive months Criteria for Restarting Primary Prophylaxis: Aged 2 to <6 years with CD4 count <200 cells/mm3 Aged ≥6 years with CD4 count <100 cells/mm3
Secondary Prophylaxis (Chronic Suppressive Therapy)	Clarithromycin 7.5 mg/kg body weight (maximum 500 mg) orally twice daily, plus Ethambutol 15–25 mg/kg body weight (maximum 2.5 g) orally once daily, with or without food Children aged >5 years who received rifabutin as part of initial treatment: Rifabutin 5 mg/kg body weight (maximum 300 mg) orally once daily with food	Azithromycin 5 mg/kg body weight (maximum 250 mg) orally once daily, plus Ethambutol 15–25 mg/ kg body weight (max 2.5 g) orally once daily, with or without food Children aged >5 years who received rifabutin as part of initial treatment: Rifabutin 5 mg/kg body weight (maximum 300 mg) orally once daily with food.	Secondary Prophylaxis Indicated: Prior disease Criteria for Discontinuing Secondary Prophylaxis Fulfillment of All of the Following Criteria: Completed ≥6 months of cART Completed ≥12 months MAC therapy Asymptomatic for signs and symptoms of MAC Aged 2 to <6 years with CD4 count >200 cells/mm3for ≥6 consecutive months Aged ≥6 years with CD4 count >100 cells/mm3for ≥6 consecutive months Criteria for Restarting Secondary Prophylaxis Aged 2 to <6 years with CD4 count <200 cells/mm3 Aged ≥6 years with CD4 count <100 cells/mm3
Treatment	Initial Treatment (≥2 Drugs): Clarithromycin 7.5–15 mg/kg body weight (maximum 500 mg/ dose) orally twice daily plus ethambutol 15–25 mg/kg body weight (maximum 2.5 g/day) orally once daily followed by chronic suppressive therapy For Severe Disease, Add: Rifabutin 10–20 mg/kg body weight (maximum 300 mg/day) orally once daily	If Intolerant to Clarithromycin: Azithromycin 10–12 mg/ kg body weight (maximum 500 mg/day) orally once daily If Rifabutin Cannot Be Administered and a Third Drug is Needed in Addition to a Macrolide and Ethambutol, or if a Fourth Drug is Needed in Addition to Rifabutin for Patients with More Severe Symptoms or Disseminated Disease: Ciprofloxacin 10–15 mg/ kg orally twice daily (maximum 1.5 g/day), or Levofloxacin 500 mg daily once daily, or Amikacin 15–30 mg/kg body weight IV in 1 or 2 divided doses (maximum 1.5 g/day)	Combination therapy with a minimum of 2 drugs is recommended for at least 12 months. Clofazimine is associated with increased mortality in HIV-infected adults and should not be used. Children receiving ethambutol who are old enough to undergo routine eye testing should have monthly monitoring of visual acuity and color discrimination. Fluoroquinolones (e.g., ciprofloxacin and levofloxacin) are not labeled for use in children aged <18 years because of concerns regarding potential effects on cartilage; use in younger individuals requires an assessment of potential risks and benefits Chronic suppressive therapy (secondary prophylaxis) is recommended in children and adults following initial therapy.

Key to Acronyms: cART = combination antiretroviral therapy; CD4 = CD4 T lymphocyte; MAC = Mycobacterium avium Complex; IV = intravenous