TABLE 1

Treatment of toxoplasmosis in immunocompetent patientsa

RegimenbComments
Pyrimethamine (100 mg daily for 1 or 2 days and then 25–50 mg daily) plus sulfadiazine (1g every 6 h [q6h]) plus folinic acid (10–20 mg daily)Blood counts, creatinine, and liver function should be monitored regularly
Adequate hydration should be ensured to prevent renal damage from crystalluria
Pyrimethamine plus folinic acid (dosing as described above) plus clindamycin (300 mg q6h)Blood counts should be monitored regularly
Clindamycin may cause diarrhea, including Clostridium difficile infection
TMP-SMX (5/25–10/50 mg/kg/day in divided doses)Blood counts, creatinine, and liver function should be monitored regularly
Adequate hydration should be ensured to prevent renal damage from crystalluria
Atovaquone (1,500 mg twice daily) ± pyrimethamine plus folinic acid (dosing as described above)Blood counts and liver function should be monitored regularly
Atovaquone should be taken with a high-fat diet
Pyrimethamine plus folinic acid (dosing as described above) plus azithromycin (250–500 mg dailyc)Blood counts should be monitored regularly
Azithromycin may cause hearing problems and a prolonged QT interval
Intravitreal clindamycin (1 mg) plus dexamethasone (400 μg)Only for ocular toxoplasmosis; may need to be repeated 1 or 2 times if response is suboptimal
  • a Treatment should be considered for immunocompetent patients with severe or persistent symptoms, ocular involvement, or laboratory-acquired infection. For ocular infection, concomitant steroids (prednisone at 0.5 to 1 mg/kg/day) with gradual tapering can be used; this decision is best made by the ophthalmologist.

  • b Folinic acid is different from folic acid.

  • c A higher dose of azithromycin (1,000 mg) should be considered for severe nonocular systemic disease.