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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