TABLE 1.
Treatment of toxoplasmosis in immunocompetent patientsa
| Regimenb | Comments |
|---|---|
| Pyrimethamine (100 mg daily for 1 or 2 days and then 25–50 mg daily) plus sulfadiazine (1g every 6 h [q6h]) plus folinic acid (10–20 mg daily) | Blood counts, creatinine, and liver function should be monitored regularly |
| Adequate hydration should be ensured to prevent renal damage from crystalluria | |
| Pyrimethamine plus folinic acid (dosing as described above) plus clindamycin (300 mg q6h) | Blood counts should be monitored regularly |
| Clindamycin may cause diarrhea, including Clostridium difficile infection | |
| TMP-SMX (5/25–10/50 mg/kg/day in divided doses) | Blood counts, creatinine, and liver function should be monitored regularly |
| Adequate hydration should be ensured to prevent renal damage from crystalluria | |
| Atovaquone (1,500 mg twice daily) ± pyrimethamine plus folinic acid (dosing as described above) | Blood counts and liver function should be monitored regularly |
| Atovaquone should be taken with a high-fat diet | |
| Pyrimethamine plus folinic acid (dosing as described above) plus azithromycin (250–500 mg dailyc) | Blood counts should be monitored regularly |
| Azithromycin may cause hearing problems and a prolonged QT interval | |
| Intravitreal clindamycin (1 mg) plus dexamethasone (400 μg) | Only for ocular toxoplasmosis; may need to be repeated 1 or 2 times if response is suboptimal |
a
Treatment should be considered for immunocompetent patients with severe or persistent symptoms, ocular involvement, or laboratory-acquired infection. For ocular infection, concomitant steroids (prednisone at 0.5 to 1 mg/kg/day) with gradual tapering can be used; this decision is best made by the ophthalmologist.
b
Folinic acid is different from folic acid.
c
A higher dose of azithromycin (1,000 mg) should be considered for severe nonocular systemic disease.