Template:Toxoplasmosis Antibiotics: Difference between revisions

Latest revision as of 13:13, 20 March 2026

Immunocompetent

Antibiotics only needed if patient has severe symptoms

Pyrimethamine 200mg PO load then 50mg PO q24hrs x 4 weeks AND
- Leucovorin 10mg PO q24hrs AND
- Sulfadiazine 1g PO q6hrs

Immunosprepressed

Pyrimethamine 200mg PO load then 75mg PO q24hrs x 4-8 weeks AND Leucovorin 25mg PO q24hrs PLUS
- Sulfadiazine 1500mg PO q6hrs OR
- Clindamycin 600mg PO or IV q6hrs OR
- Azithromycin 1200mg PO q24hrs OR
- Atovaquone 1500mg PO q12hrs

OR

TMP/SMX 5mg/kg IV q12hrs

Pregnant

Spiramycin 1g PO q8hrs^[1]
- If amniotic fluid is positive treat with 3 weeks of pyrimethamine (50 mg/day orally) + sulfadiazine (3 g/day orally in 2-3 divided doses)
- Alternate with a 3-week course of Spiramycin 1 g 3 times daily OR
Pyrimethamine (25 mg/day orally) and sulfadiazine (4 g/day orally) divided 2 or 4 times daily until delivery AND
- Leucovorin 10-25 mg/day orally to prevent bone marrow suppression
Dapsone 50mg PO QD; Off label use

Congenital/Pediatric

Pyrimethamine 2mg/kg/day PO x 2 days then 1mg/kg/day x 2-6 months, then 1mg/kg MWF AND
- Sulfadiazine 50mg/kg PO BID AND
- Leucovorin 10mg PO 3x/week
Duration: 12 months for congenital toxoplasmosis
Alternative: TMP/SMX 5mg/kg (TMP) PO/IV q12hrs
Clindamycin 20-30mg/kg/day PO/IV divided q6hrs (max 2.4g/day) if sulfa allergic
Spiramycin 50-100mg/kg/day PO divided q8hrs

↑ Paquet C, Yudin MH. Toxoplasmosis in pregnancy: prevention, screening, and treatment. J Obstet Gynaecol Can. Jan 2013;35(1):78-9.

[1] Paquet C, Yudin MH. Toxoplasmosis in pregnancy: prevention, screening, and treatment. J Obstet Gynaecol Can. Jan 2013;35(1):78-9.

[1]

@@ Line 1: / Line 1: @@
 ====Immunocompetent====
 ''Antibiotics only needed if patient has severe symptoms''
-*[[Pyrimethamine]] 200mg PO one dose (for loading) THEN 50mg PO q24hrs x4wks AND
+*{{AntibioticDose|disease=Toxoplasmosis|drug=Pyrimethamine|dose=200mg PO load then 50mg PO q24hrs x 4 weeks|context=Immunocompetent with Leucovorin and Sulfadiazine|population=Adult}} AND
-**[[Leucovorin]] 10mg PO q24hrs AND
+**{{AntibioticDose|disease=Toxoplasmosis|drug=Leucovorin|dose=10mg PO q24hrs|context=Immunocompetent adjunct|population=Adult}} AND
-**[[Sulfadiazine]] 1g PO q6hrs
+**{{AntibioticDose|disease=Toxoplasmosis|drug=Sulfadiazine|dose=1g PO q6hrs|context=Immunocompetent with Pyrimethamine|population=Adult}}
 ====Immunosprepressed====
-*[[TMP/SMX]] 5mg/kg IV q12hrs OR
+*{{AntibioticDose|disease=Toxoplasmosis|drug=Pyrimethamine|dose=200mg PO load then 75mg PO q24hrs x 4-8 weeks|context=Immunosuppressed|population=Adult}} AND {{AntibioticDose|disease=Toxoplasmosis|drug=Leucovorin|dose=25mg PO q24hrs|context=Immunosuppressed adjunct|population=Adult}} PLUS
-*[[Pyrimethamine]] 200mg PO one dose (for loading) THEN 75mg PO q24hrs x4-8wks AND [[Leucovorin]] 25mg PO q24hrs PLUS
+**{{AntibioticDose|disease=Toxoplasmosis|drug=Sulfadiazine|dose=1500mg PO q6hrs|context=Immunosuppressed with Pyrimethamine|population=Adult}} OR
-**[[Sulfadiazine]] 1500mg PO q6hrs OR
+**{{AntibioticDose|disease=Toxoplasmosis|drug=Clindamycin|dose=600mg PO or IV q6hrs|context=Immunosuppressed alt|population=Adult}} OR
-**[[Clindamycin]] 600mg PO or IV q6hrs OR
+**{{AntibioticDose|disease=Toxoplasmosis|drug=Azithromycin|dose=1200mg PO q24hrs|context=Immunosuppressed alt|population=Adult}} OR
-**[[Azithromycin]] 12000mg PO q24hrs OR
 **[[Atovaquone]] 1500mg PO q12hrs
+OR
+*{{AntibioticDose|disease=Toxoplasmosis|drug=Trimethoprim-Sulfamethoxazole DS|dose=5mg/kg IV q12hrs|context=Immunosuppressed alt|display=TMP/SMX|population=Adult}}
 ====Pregnant====
-*[[Spiramycin]] 1 g orally every 8 hours<ref>Paquet C, Yudin MH. Toxoplasmosis in pregnancy: prevention, screening, and treatment. J Obstet Gynaecol Can. Jan 2013;35(1):78-9.</ref>
+*{{AntibioticDose|disease=Toxoplasmosis|drug=Spiramycin|dose=1g PO q8hrs|context=Pregnant|population=Adult}}<ref>Paquet C, Yudin MH. Toxoplasmosis in pregnancy: prevention, screening, and treatment. J Obstet Gynaecol Can. Jan 2013;35(1):78-9.</ref>
 **If amniotic fluid is positive treat with 3 weeks of pyrimethamine (50 mg/day orally) + sulfadiazine (3 g/day orally in 2-3 divided doses)
 **Alternate with a 3-week course of Spiramycin 1 g 3 times daily OR
 *[[Pyrimethamine]] (25 mg/day orally) and sulfadiazine (4 g/day orally) divided 2 or 4 times daily until delivery AND
 **[[Leucovorin]] 10-25 mg/day orally to prevent bone marrow suppression
+*{{AntibioticDose|drug=Dapsone|dose=50mg PO QD; Off label use|context=Toxoplasmosis prophylaxis|disease=Toxoplasmosis|population=Adult}}
+====Congenital/Pediatric====
+*{{AntibioticDose|disease=Toxoplasmosis|drug=Pyrimethamine|dose=2mg/kg/day PO x 2 days then 1mg/kg/day x 2-6 months, then 1mg/kg MWF|context=Congenital/Pediatric|population=Pediatric}} AND
+**{{AntibioticDose|disease=Toxoplasmosis|drug=Sulfadiazine|dose=50mg/kg PO BID|context=Congenital/Pediatric|population=Pediatric}} AND
+**{{AntibioticDose|disease=Toxoplasmosis|drug=Leucovorin|dose=10mg PO 3x/week|context=Congenital/Pediatric adjunct|population=Pediatric}}
+*Duration: 12 months for congenital toxoplasmosis
+*Alternative: {{AntibioticDose|disease=Toxoplasmosis|drug=Trimethoprim-Sulfamethoxazole DS|display=TMP/SMX|dose=5mg/kg (TMP) PO/IV q12hrs|context=Pediatric Immunosuppressed alt|population=Pediatric}}
+*{{AntibioticDose|disease=Toxoplasmosis|drug=Clindamycin|dose=20-30mg/kg/day PO/IV divided q6hrs (max 2.4g/day)|context=Pediatric Sulfa Allergy alt|population=Pediatric}} if sulfa allergic
+*{{AntibioticDose|disease=Toxoplasmosis|drug=Spiramycin|dose=50-100mg/kg/day PO divided q8hrs|context=Pediatric/Congenital alt|population=Pediatric}}