Toxoplasmosis Treatment

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The therapy of choice for toxoplasmosis consists of the combination of pyrimethamine, sulfadiazine, and leucovorin. Pyrimethamine, a dihydrofolate inhibitor, is the primary anti-toxoplasmosis agent and is able to penetrate the blood brain barrier. Sulfadiazine is a folic acid synthesis inhibitor that is a designated orphan product for synergistic use with pyrimethamine to treat toxoplasmosis. For patients with a documented sulfa allergy, clindamycin and atovaquone may be used as alternative therapeutic agents; however, because sulfadiazine is so integral to the success of toxoplasmosis treatment, it is recommended that clinicians attempt sulfa desensitization in these patients. Leucovorin, or folinic acid, reduces the risk of developing pyrimethamine toxicities such as nausea, rash, and bone marrow suppression. Increasing the leucovorin dose may also reverse pyrimethamine toxicities in some cases. Folic acid should not be used as a substitute for leucovorin in toxoplasmosis treatment. Two other drugs used in toxoplasmosis treatment include spiramycin and trimethoprim/sulfamethoxazole (TMP-SMX). Because pyrimethamine is teratogenic in the first trimester, the macrolide spiramycin is used as toxoplasmosis monotherapy in acutely infected…show more content…
If a patient with suspected infection has a negative PCR test and fetal ultrasounds continue to demonstrate no signs of congenital toxoplasmosis, spiramycin therapy should be continued until delivery. If the patient is diagnosed, spiramycin should be discontinued at 18 weeks, and combination therapy should be initiated until delivery. It is strongly recommended that pregnant patients with acute infection consult with experts at either the Palo Alto Medical Foundation Toxoplasma Serology Laboratory or the U.S. National Collaborative Treatment Trial
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