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Step 1
Provide care for toxoplasmosis on an outpatient basis for immunocompetent patients or those with ocular toxoplasmosis. Immunocompromised patients and those with toxoplasmosis of the central nervous system should be initially treated as inpatients. Asymptomatic patients do not need treatment if they are older than five.
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Step 2
Continue treatment in symptomatic patients until they are immune to toxoplasmosis. Patients with an active infection of HIV and a CD4+ count below 200 should continue to receive suppressive therapy.
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Step 3
Use chemotherapy primarily against the tachyzoite form of toxoplasma gondii. The recommended drugs do not affect the encysted form. The most effective agent is pyrimethamine and is included in most regimens. Leucovorin should always be administered with pyrimethamine to prevent bone marrow suppression. An additional drug such as clindamycin or sulfadiazine is normally added as well.
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Step 4
Combine pyrimethamine with sulfamerazine, sulfamethazine and sulfapyrazine. This combination also is effective against tachyzoites and has a synergistic effect.
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Step 5
Use atovaquone, azithromycin, clarithromycin, cotrimoxazole or dapsone as alternatives. The efficacy of these drugs is not well established, so they should always be combined with pyrimethamine.
