Archer 66 ....need help - forever07

[ArchivalUser]

they ar e a lot of controversies on some of these topics; MTB says onething and UW says another and now Acher. unfortunate!

[ArchivalUser]

Misshy ,I am copying pasting from "cecil's internal medicine 23 edition". I think it will help.

TABLE 370-3 -- PRIMARY PROPHYLAXIS FOR TOXOPLASMOSIS IN AIDS PATIENTS[*]
FOR TOXOPLASMA GONDII–SEROPOSITIVE HIV-INFECTED INDIVIDUALS[†]
SUGGESTED REGIMEN (GRADE A EVIDENCE)

Trimethoprim-sulfamethoxazole 1 double-strength tablet daily
ALTERNATIVE REGIMENS (GRADE B EVIDENCE)
Pyrimethamine-dapsone Pyrimethamine, 50 mg once each week, plus dapsone, 50 mg qd, plus folinic acid (leucovorin), 25 mg qd
Pyrimethamine, 75 mg once each week, plus dapsone, 200 mg once each week, plus folinic acid (leucovorin), 25 mg qd

Trimethoprim-sulfamethoxazole 1 single-strength tablet daily
FOR PREVENTION OF CONGENITAL TRANSMISSION OF T.
GONDII IN SEROPOSITIVE, HIV-INFECTED PREGNANT WOMEN[‡]
Spiramycin 1 g q8h

Good luck

[ArchivalUser]

from UPTODATE.COM

Toxoplasma

We recommend TMP-SMX as first-line preventive therapy (one double strength tablet per day) in patients with a CD4 count

[ArchivalUser]

oxoplasma

We recommend TMP-SMX as first-line preventive therapy (one double strength tablet per day) in patients with a CD4 count < 100 cells/microL who are toxoplasma seropositive (Grade 1C). (See 'Toxoplasma' above.)
For patients who have contraindications to TMP-SMX, we recommend dapsone (200 mg orally per week) plus pyrimethamine (75 mg orally per week) plus leucovorin (25 mg orally per week) (Grade 1B).
In the patient who is intolerant or allergic to the above two regimens, we suggest atovaquone (1500 mg once daily) with or without pyrimethamine/leucovorin (Grade 2C). Monotherapy with dapsone, pyrimethamine, azithromycin, or clarithromycin is not recommended.
In pregnant women, we recommend trimethoprim-sulfamethoxazole for the prophylaxis of toxoplasmosis starting in the second trimester (Grade 2C). Pyrimethamine is teratogenic and should not be used during pregnancy.
Patients who are seronegative for toxoplasma should be counseled to avoid eating undercooked meats (eg, lamb, beef, pork) and to use gloves when cleaning cat litter boxes.
Mycobacterium avium complex

[ArchivalUser]

angleman, bactrim is best drug for toxo prophylaxis agreed. But the question is not on prophylaxis for toxo.

But given that all dapsone, atovaquone and bactrim have some activity against toxo, the likelihood that it is the thing we are dealing here especially, with a single brain lesion is low. So I think in such lesser clinical probability with a single lesion, serology is a better idea than doing straight away empiric therapy.

do you think B should be the choice? just asking, i love your discussions

thanks

[ArchivalUser]

LOL buddy.
You have copied pasted a very costly reference. I tried to log in that website ,that asks for money.
You are great Misshyd.


Serology is good idea buddy.
Good luck

[ArchivalUser]

Great thanks for nice discussion!

[ArchivalUser]

so final ans c?

that is a tough one

thx