Table 1.

Recommended treatment options for congenital toxoplasmosis.

Clinical entity	Treatment	Regimen	Administration	Duration
Acute toxoplasmosis in pregnancy (no proof of fetal infection)	SPIa	1 g [3 million units] ×3/d	p.o.	Until amniocentesis (AF PCR result) and/or deliveryb
Fetal toxoplasmosis	Combination 1 + 2 + 3		p.o.	Until delivery
	1. PYR	50 mg/d
	2. SDZ	4–6 g/d
	3. FA	50 mg/w (once/w)
Neonatal toxoplasmosis	Combination 1 + 2+3c		p.o.	12mo
	1. PYR	2 mg/kg/d for 2d, then 1 mg/kg/d for 6 mo (or only 2 mo if asymptomatic) and then 1 mg/kg 3×/w for the last 6 mo (or 10 mo)
	2. SDZ	100 mg/kg/d
	3. FA	15 mg/w (3 × 5 mg)d

SPI: Spiramycin; PYR: Pyrimethamine; SDZ: Sulphadiazine; FA: Folinic acid; p.o.: per os; h: hour; d: day; w: week; gw: gestational week; mo: month; AF: amniotic fluid.

^aFor infections diagnosed later than 14 gw, US and some European centres (e.g. Austrian) recommend immediate PYR + SDZ + FA treatment (that may be switched to SPI if AF PCR result comes out negative) (Maldonado, Read and Committee on infectious diseases, 2017; Dunay et al., 2018).

^bIf fetal infection was not diagnosed or even tested (late pregnancy infections).

^cElevated CSF protein concentration (> 1 g/dL) or retinitis indicate introduction of prednisolone 1 mg/kg (p.o.)

^dNeutropenia indicates higher dosage (up to 20 mg/d), followed by 10 mg/d from one month of age (4.5 kg body weight) for 11 months.