Table 2.

Therapy and prophylaxis of cerebral toxoplasmosis^a

Therapy/prophylaxis	Drug	Therapeutic regimen
Acute therapy		Duration: at least 4 weeks
First choice	Sulfadiazineb + Pyrimethamine	4 × 1–1.5 g p.o. + 2 × 50 mg p.o. (for 3 days, then 50–75 mg/d) + folinic acid 15 mg p.o.
First choice	Clindamycin + Pyrimethamine	4 × 600 mg i.v. (or p.o.) + 2 × 50 mg (for 3 days, then 50–75 mg/day) + folic acid 15 mg p.o.
Alternative	TMP/SMX	15 mg of TMP component/kg/d, in 3–4 doses a day
	Atovaquone + Pyrimethamine	2 × 1,500 mg p.o. (with food) + 2 × 50 mg p.o. (for 3 days, then 50–75 mg qd) plus folinic acid 15 mg p.o. (CDC: loading dose 200 mg, followed by 75 mg/day)
	Depending on findings additional dexamethasone therapy	3–4 × 4–8 mg/day
Maintenance therapy/secondary prophylaxis
Possible	As for acute therapy	As for acute therapy, but halve dose Discontinue if >200 CD4 T-cells/μl >6 months (if MRI is normal or without contrast enhancement)
	TMP/SMX	1 × 960 mg p.o.
Alternative	Dapsone + Pyrimethamine	50 mg p.o. qd + 50 mg p.o. qd + folinic acid 15 mg p.o.
Primary prophylaxis (necessary only if Toxo IgG is positive)
First choice	TMP/SMX	1 × 480 mg p.o. or 960 mg p.o. 3×/week
Alternative	Dapsone	1 × 100 mg p.o. qd
Alternative	Dapsone + Pyrimethamine	1 × 50 mg p.o. qd + 1 × 50 mg/week + folinic acid 1 × 30 mg/week

Toxo IgG Toxoplasma immunoglobulin G, MRI magnetic resonance imaging, CDC Centers for Disease Control and Prevention

^aUnless otherwise specified, daily doses

^bCave: acute renal failure due to crystalluria syndrome! Increase fluid intake