From the Guidelines
Treatment of congenital toxoplasmosis typically involves a combination of pyrimethamine, sulfadiazine, and leucovorin (folinic acid) for 12 months, as recommended by the most recent and highest quality study 1. The standard regimen includes:
- Pyrimethamine at 2 mg/kg/day for 2 days, then 1 mg/kg/day for 2-6 months, followed by 1 mg/kg/day three times weekly for the remainder of the year
- Sulfadiazine at 100 mg/kg/day in two divided doses
- Leucovorin (folinic acid) at 10 mg three times weekly to prevent bone marrow suppression caused by pyrimethamine For infants with severe disease, particularly those with chorioretinitis or CNS involvement, corticosteroids (prednisone 1 mg/kg/day in two divided doses) may be added until ocular or CSF inflammation resolves, as suggested by expert opinion 1. Regular monitoring is crucial, including:
- Complete blood counts every 1-2 weeks
- Ophthalmologic examinations every 3 months
- Neurological assessments This aggressive treatment approach is necessary because the parasite Toxoplasma gondii forms tissue cysts that can cause progressive damage to the brain, eyes, and other organs if left untreated. Early treatment significantly improves outcomes by preventing further parasite replication and reducing inflammatory damage, particularly in the developing brain and retina, as supported by the evidence from the study 1. It is also important to note that the management of infants with confirmed or suspected congenital toxoplasmosis should be individualized, taking into account the severity of the disease and the presence of any underlying conditions, such as HIV infection, as recommended by the guidelines 1.
From the FDA Drug Label
Pyrimethamine is indicated for the treatment of toxoplasmosis when used conjointly with a sulfonamide, since synergism exists with this combination. SYSTEMIC SULFONAMIDES ARE CONTRAINDICATED IN INFANTS UNDER 2 MONTHS OF AGE except as adjunctive therapy with pyrimethamine in the treatment of congenital toxoplasmosis.
Treatment options for congenital toxoplasmosis include:
- Pyrimethamine in combination with a sulfonamide, such as sulfadiazine, due to synergism between the two drugs 2
- Sulfadiazine can be used as adjunctive therapy with pyrimethamine in infants under 2 months of age for the treatment of congenital toxoplasmosis 3
From the Research
Treatment Options for Congenital Toxoplasmosis
- There are two kinds of treatment available for congenital toxoplasmosis: prenatal and postnatal 4.
- Prenatal treatment involves administering spiramycin to pregnant women who have seroconverted to prevent mother-to-child transmission 4, 5, 6, 7.
- If fetal infection is confirmed, the treatment is changed to a combination of pyrimethamine and sulfadiazine 4, 5, 8, 7.
- Postnatal treatment for infected newborns typically involves administering pyrimethamine and sulfadiazine for 12 months 5.
- Some studies suggest that a combination of spiramycin and cotrimoxazole may be effective in preventing fetal congenital toxoplasmosis and reducing sequelae in case of in-utero infection 6.
Effectiveness of Treatment
- The effectiveness of treatment for congenital toxoplasmosis is still a topic of debate, with some studies suggesting that prenatal treatment can reduce the risk of mother-to-child transmission and the severity of fetal infection 8, 6, 7.
- However, other studies have found that the benefits of antenatal treatment are controversial, and that long-term ophthalmological follow-up is still necessary to monitor for potential complications such as chorioretinitis 4, 5.