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