Secondary prophylaxis for Toxoplasma gondii encephalitis in adults
Adults who have completed primary treatment for T. gondii should receive secondary prophylaxis to suppress infection. Continue secondary prophylaxis while the patient remains immunocompromised. For patients with HIV infection who are responding to antiretroviral therapy, continue secondary prophylaxis until CD4 count is more than 200 cells/microlitre for 6 months or longer.
For T. gondii encephalitis secondary prophylaxis (maintenance therapy) in adults, usePanel on guidelines for the prevention and treatment of opportunistic infections in adults and adolescents:
sulfadiazine 1 g orally, 12-hourly1. For dosage adjustment in adults with kidney impairment, see sulfadiazine dosage adjustmentsulfadiazinesulfadiazinesulfadiazine
PLUS
pyrimethamine 25 mg orally, daily2pyrimethaminepyrimethaminepyrimethamine
PLUS
calcium folinate 15 mg orally, daily3.calcium folinatecalcium folinatecalcium folinate
For adults hypersensitive to sulfonamides, use as a 3-drug regimen:
clindamycin 600 mg orally, 8-hourlyclindamycinclindamycinclindamycin
PLUS
pyrimethamine 25 mg orally, dailypyrimethaminepyrimethaminepyrimethamine
PLUS
calcium folinate 15 mg orally, daily3.calcium folinatecalcium folinatecalcium folinate
If trimethoprim+sulfamethoxazole was used for primary treatment, useInfectious Diseases Society of America (IDSA) 2017:
1trimethoprim+sulfamethoxazole 160+800 mg orally, twice daily. For dosage adjustment in adults with kidney impairment, see trimethoprim+sulfamethoxazole dosage adjustmenttrimethoprim + sulfamethoxazoletrimethoprim+sulfamethoxazoletrimethoprim+sulfamethoxazole
OR
2trimethoprim+sulfamethoxazole 160+800 mg orally, once daily4. For dosage adjustment in adults with kidney impairment, see trimethoprim+sulfamethoxazole dosage adjustment.