cotrimoxazole is combination two antibiotics (trimethoprim and sulfamethoxazole). Tradenames include Septrin and Bactrim.

Abbreviations for this combination include SXT, TMP-SMX, TMP-SMZ or TMP-sulfa.

Cotrimoxazole is commonly used in HIV care as a prophylaxis against PCP and toxoplasmosis. Everyone with a CD4 count that is less than 200 cells/mm3 need to also take cotrimoxazole until their CD4 count becomes higher.

Different guidelines recommend continuing with cotrimoxazole at different CD4 counts, depending on which country you live in. Sometimes this is at 100, 200, 350 or sometimes higher.

After being on effective ART for 3 to 6 months, cotrimoxazole can be stopped after the CD4 count increases to above 100 cells/mm3. This is only if they have never had PCP. Anyone who has previously had PCP, it is recommended to continue until the CD4 count is above 200 cells/mm3. This is based on EACS guidelines (v11.1, October 2022).

In countries with high risk of malaria or severe bacterial infections, prophylaxis should continue, irrespective of CD4 count on ART. There are also different recommendations for children and in other specific circumstances. (WHO consolidated guidelines, 2021)

See PCP and toxoplasmosis sections of the training manual.