TABLE 11

Proposed Postnatal Treatment Protocols, According to the Toxoplasmosis Center at the University of Chicago and European Toxoplasmosis Centers

Author and RegimenDosing FrequencyDuration
McLeod et al110,a (US cohort)
 P/SEvery day for the first 2 (or 6) months and 3 times per week after the first 2 months (or 6 months)12 months (total)
 Pyrimethamine
  First 2 days: 1 mg/kg per dose BID for 2 days
  From day 3 of life and for the first 2 months (or 6 months)a: 1mg/kg per day for 2–6 months
  After the first 2 months (or 6 months): 1 mg/kg per day TIW for up to 12 months of therapy total
 Sulfadiazine: 100 mg/kg per day divided BID for 12 months
 Folinic acid: 10 mg TIW for 12 months
Wallon et al2 (Lyon cohort)
 P/S: for the first 2 monthsQ day12 months (total)
 Pyrimethamine/sulfadoxine: for the next 10 monthsQ 15 days
Berrebi et al129 (Toulouse cohort)
 Pyrimethamine/sulfadoxinebQ 15 days24 months (total)
  • ≤10 kg: pyrimethamine: 6.25 mg + sulfadoxine: 125 mg Q 15 days
  • >10 kg: pyrimethamine: 12.5 mg + sulfadoxine: 250 mg Q 15 days
 Folinic acid: 50 mg Q 15 days
Kieffer et al97 (French experience: Paris/Lyon/Marseille)
 Paris cohort: P/SQ day12 months (total)
  Pyrimethamine:
   1 mg/kg per day for the first 2 months
   0.5 mg/kg per day for the following 10 months
  Sulfadiazine: 80–100 mg/kg per day Q days for 12 months
  Folinic acid: 50 mg Q 7 days for 12 months
 Lyon cohort: P/S for the first 2 months followed by pyrimethamine/sulfadoxine for the following 10 months
  P/S for the first 2 monthsQ day (P/S) (protocol after 2002)12 months (total) (but also 12–14 months reported)2
   Pyrimethamine: 0–2 months: 1 mg/kg per day (protocol after 2002)
   Sulfadiazine: 0-2 mo: 100 mg/kg per day divided TID Q day (protocol after 2002)
  Pyrimethamine/sulfadoxine for the following 10 monthsQ 10 days (pyrimethamine/sulfadoxine)
   Pyrimethamine: 1.25 mg/kg Q 10 d for the following 10 months
   
   Sulfadoxine: 25 mg/kg Q 10 days for the following 10 months
   Folinic acid: 50 mg every 7 days for 12 months
 Marseille cohort: pyrimethamine/sulfadoxine
  Pyrimethamine/sulfadoxine (as in the Lyon cohort)
  Pyrimethamine: 1.25 mg/kg Q 10 days for 12 monthsQ 10 days (pyrimethamine/sulfadoxine)12 months (total)
  Sulfadoxine: 25 mg/kg Q 10 days for 12 months
  Folinic acid: 50 mg every 7 days for 12 months
Kieffer and Wallon184 (recent expert literature review)
 Kieffer et al proposed the following 2 postnatal treatment protocols for a total duration of 12 months:
 A. P/S for 12 monthsQ day (P/S)12 months (total)
  Pyrimethamine:
   1 mg/kg per day for 2 months
   0.5 mg/kg per day for the following 10 months
  Sulfadiazine: 100 mg/kg per day divided BID for 12 months
 or
 B. Pyrimethamine/sulfadoxine for 12 monthsQ 10 days (pyrimethamine/sulfadoxine)12 months (total)
  Pyrimethamine: 1.25 mg/kg every 10 days for 12 months
  Sulfadoxine: 25 mg/kg every 10 days for 12 months
  Folinic acid: 50 mg every 7 days for 12 months
Hotop et al4 (German cohort)
 For asymptomatic infants:
  P/S for 3 monthsQ day3 or 6 or 12 months total (according to the severity of the disease)
  Pyrimethamine: 1 mg/kg per day for 3 months
  Sulfadiazine: 50 mg/kg per day for 3 months
  Folinic acid for 3 months
 For symptomatic infants (mild ventriculomegaly or intracranial calcifications but with normal neurologic examination or retinal scars without active retinal inflammation)
   P/S for 6 months
   Pyrimethamine: 1 mg/kg per day for 6 months
   Sulfadiazine: 100 mg/kg per day for 6 months
 For severely symptomatic infants (seizures, abnormal neurologic examination, or active chorioretinitis)
   P/S for 12 months
   Pyrimethamine: 1 mg/kg per day for 12 months
   Sulfadiazine: 100 mg/kg per day for 12 months
Röser et al114 (Danish cohort)
 P/S + folinic acid for 3 months3 months
  • Ongoing clinical trials for postnatal treatment of CT: There is an ongoing RCT that has been recently launched in France (TOSCANE trial201) to compare the efficacy of P/S for 3 months versus 12 months in asymptomatic children with CT with regard to the development of chorioretinitis within a 2-year follow-up (estimated study completion date: September 2016). BID, twice per day; Q, ; TIW, 3 times per week.

  • a See footnote in Table 10 on the comparative efficacy of 2 months versus 6 months of intensive therapy.

  • b The sulfadoxine half-life of 120–195 hours allows for a more simple administration scheme. However, should an allergic reaction occur, the clinical implications may be more significant because, due to the long half-life, there would be a continued drug exposure, even after medication discontinuation.