Treatment of Toxoplasmosis During Pregnancy
Treatment Algorithm Based on Gestational Age and Infection Status
- For pregnant women with active toxoplasmosis, the recommended treatment depends on timing of infection, with spiramycin used before 18 weeks gestation and pyrimethamine/sulfadiazine/folinic acid used after 18 weeks or when fetal infection is confirmed, as recommended by the American Academy of Pediatrics 1
- Spiramycin is the first-line treatment for suspected or confirmed infection before 18 weeks gestation, with a dosage of 1g or 3 million IU orally three times daily, according to the American Academy of Pediatrics 1
- Pyrimethamine plus sulfadiazine plus folinic acid is recommended for suspected or confirmed infection at or after 18 weeks gestation, or when amniotic fluid PCR is positive for T. gondii, or when abnormal fetal ultrasound findings suggestive of congenital toxoplasmosis are present, as recommended by the American Academy of Pediatrics 1
Consultation Requirements
- Pregnant women with evidence of primary infection or active toxoplasmosis should be evaluated in consultation with appropriate specialists, as recommended by the Centers for Disease Control and Prevention 2, the American College of Physicians 3, and the Centers for Disease Control and Prevention 4
Special Situations
- For HIV-infected pregnant women, TMP-SMZ can be administered for prophylaxis against toxoplasmosis encephalitis, as recommended by the American College of Physicians 5 and the Centers for Disease Control and Prevention 2
- For women with history of toxoplasmosis who are now immunosuppressed, prophylaxis may be required, as recommended by the Centers for Disease Control and Prevention 2