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Sunday, June 7, 2015

Treatment For Toxoplasma Gondii Encephalitis

Infection/Condition and Likely Organism
Preferred treatment
Alternative treatment
Comments
Acute Infection
(up to 97% patients are
Toxo IgG +ve)
Pyrimethamine* 200mg PO loading dose followed by Pyrimethamine 50mg (if BW≤60kg), 75mg (if BW>60kg) PO q24h
PLUS
Folinic acid 10-25mg PO q24h
PLUS
Clindamycin 600mg IV/PO q6h for at least 6 weeks
OR
Sulfadoxine/Pyrimethamine 500/25mg (Fansidar®) PO 1 tab q12h
PLUS
Folinic acid 10-25mg PO q24h
PLUS
Clindamycin 600mg IV/PO q6h for at least 6 weeks
Pyrimethamine* (dosing as per preferred regime)
PLUS
Folinic acid 10-25mg PO q24h
PLUS
Sulfadiazine* 1-1.5gm PO q6h
for at least 6 weeks

OR
 Trimethoprim/Sulfamethoxazole (5mg/kg TMP/ 25mg/kg SMX) IV/PO q12h for at least 6 weeks
Adjunctive corticosteroids (e.g. dexamethasone) should be administered when clinically indicated to treat a mass effect associated with focal lesions or associated edema. Because of the potential immunosuppressive effects of corticosteroids, they should be discontinued as soon as clinically feasible
*Requires DG approval
Suppressive/ Maintenance Therapy

Pyrimethamine* 25-50mg PO q24h
PLUS
Clindamycin 600mg PO q8h
PLUS
Folinic acid 10-25mg q24h
Pyrimethamine* 25-50mg PO q24h
PLUS
Folinic acid 10-25mg q24h
PLUS
Sulphadiazine* 0.5-1g PO q6h
OR
Trimethoprim/ Sulfamethoxazole 160/800mg PO q12h
Discontinuation:
Consider when on HAART, CD4 >200 >3 months and viral load well suppressed
*Requires DG approval
Primary Prophylaxis
Indications:
ToxoIgG +ve with CD4<100

Trimethoprim/ Sulfamethoxazole
160/800mg PO q24h


Dapsone 50mg PO q24h
PLUS
Pyrimethamine* 50mg PO q7d
PLUS
Folinic acid 25mg PO q7d
 
OR
Dapsone 200mg PO q7d
PLUS
Pyrimethamine* 75mg P q7d
PLUS
Folinic Acid 25mg PO q7d
All the recommended regimens for preventing 1st episode of toxoplasmosis are also effective in preventing PCP
*Requires DG approval

 

REFERENCE:
National Antibiotic Guideline 2014

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