Preferred T. gondii prophylaxis

Trimethoprim+sulfamethoxazole is the most effective prophylaxis against Toxoplasma gondii. Prophylaxis against Pneumocystis jirovecii pneumonia (PJP) with trimethoprim+sulfamethoxazole protects against T. gondii infection. For trimethoprim+sulfamethoxazole regimens, see here.

Note: Before prescribing toxoplasmosis prophylaxis, check if the patient is taking prophylaxis against Pneumocystis jirovecii pneumonia.

Assess patients reporting hypersensitivity to trimethoprim+sulfamethoxazole. Desensitisation (see Principles of antimicrobial desensitisation) is an option for clinically stable patients; however, do not desensitise patients with severe hypersensitivity (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome / toxic epidermal necrolysis [SJS/TEN]) or if adherence to therapy is unlikely. If 1 day of therapy is missed, the patient’s hypersensitivity will return and desensitisation must be performed again. Seek expert advice if desensitisation is being considered. If desensitisation is not an option, see Alternative T. gondii prophylaxis.

Note: Assess patients reporting hypersensitivity to trimethoprim+sulfamethoxazole.