Treatment of Acute Ocular Toxoplasmosis in Pregnancy — Third Trimester
Acute ocular toxoplasmosis occurring during the third trimester of gestation requires a pregnancy-specific treatment strategy. The choice of regimen at this gestational stage differs from earlier trimesters and must account for the patient's pregnant status.
This protocol applies to patients presenting with acute ocular toxoplasmosis who are in the third trimester of pregnancy. The therapeutic approach is determined by gestational stage, with distinct regimens defined for each trimester of gestation.
Treatment Approach
The third-trimester regimen is anchored by spiramycin in combination with select co-agents specific to this gestational stage. Alternative antiparasitic combinations are also available. The complete regimen — including sequencing, all options, and clinical criteria for choosing among them — is detailed in the full protocol.
References
DOI: 10.1007/s10792-021-01994-9
- During pregnancy, the therapeutic regimens are: (1) First trimester: spiramycin, and sulfadiazine; (2) Second trimester (>14 weeks): spiramycin, sulfadiazine, pyrimethamine, and folinic acid; (3) Third trimester: spiramycin, pyrimethamine and folinic acid.
- Medications are given in lower doses for three weeks and can be repeated, if required, after 21 days.
- Clindamycin and azithromycin or clindamycin and atovaquone (± systemic corticosteroid) are discussed as alternatives.
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