TABLE 3.
Treatment of acute toxoplasmosis in pregnant women and newborns
| Infection stage | Regimen | Comments |
|---|---|---|
| Maternal infection at <14 weeks of gestation, no fetal infection | Spiramycin (1 g [3 million units] every 8 h until delivery) | Spiramycin is not effective for treating established fetal infection and hence should be used only for prevention of vertical transmission |
| Amniocentesis and fetal ultrasound should be performed when feasible to rule out fetal infection | ||
| Maternal infection at >14 weeks of gestationa | Pyrimethamine (100 mg daily for 2 days and then 50 mg daily) plus sulfadiazine (1 g q8h [body wt of <80 kg] or 1 g q6h [body wt of ≥80 kg]) plus folinic acid (10–20 mg daily pending fetal USG and amniocentesis) | Pyrimethamine is teratogenic and should not be used in early pregnancy |
| If fetus is confirmed to be infected (abnormal USG and/or positive amniotic fluid PCR), continue pyrimethamine plus sulfadiazine plus folinic acid until delivery | Serial fetal USG and amniotic fluid PCR should be performed at 18 weeks of gestation | |
| If fetus is not infected (e.g., negative USG and amniotic fluid PCR), pyrimethamine plus sulfadiazine plus folinic acid may be switched to spiramycin | ||
| Alternatively, pyrimethamine plus sulfadiazine plus folinic acid can be continued until delivery or alternated with spiramycin on a monthly basis | ||
| Congenital infection in newborns | Pyrimethamine (1 mg/kg q12h for 2 days and then 1 mg/kg/day for 2–6 mo and then 1 mg/kg/day 3 times a week) plus sulfadiazine (50 mg/kg q12h) plus folinic acid (10 mg 3 times a week) | Treatment should be started as soon as feasible after birth and continued for at least 1 year |
a
The 14-week cutoff period for starting pyrimethamine and sulfadiazine in pregnant women may vary in different countries.