Page 233 - HPP ANTIMICROBIAL GUIDELINE 2018

Infection/Condition Suggested Treatment Comments
Preferred Alternative

Congenital Toxoplasmosis Drug regimen not definitively established. Clinical trials ongoing.
T. gondii
Prednisolone (0.5 mg twice per day) can be added if cerebrospinal fluid (CSF) protein is >1 gm/dL or when active
chorioretinitis threatens vision and continued until resolution of elevated CSF protein or active chorioretinitis that
threatens vision.

Clindamycin may be substituted for sulfadiazine in children with G6PD deficiency or who develop allergy to sulfadiazine

Regular FBC recommended: Main adverse effect of pyrimethamine is neutropenia.
The folinic acid dose should be increased if the ANC falls below 1000 cells/microL.
Pyrimethamine should be temporarily withheld if the ANC is below 500 cells/microL.
Persistent neutropenia despite withholding of pyrimethamine may be caused by Sulfadiazine.

Pyrimethamine (1.25 mg/kg every 15 days)
PLUS
Sulfadoxine (25 mg/kg every 15 days) for 24 months

PLUS
Folinic Acid, 5 mg/week PO
(IV formulation can be used for oral)

Herpes Simplex Isolate Ocular involvement requires topical antiviral
Neonatal Screen for other STDs
• Localized skin, eye, and For CNS disease, repeat LP at end therapy for HSV PCR and treat till negative
mouth Investigate and treat parents
• Central nervous system with Recurrence of HSV can occur and may be a lifelong problem
or without SEM
• Disseminated disease Duration:
involving multiple organs Acyclovir 60mg/kg/day IV q8h Skin, eyes, mouth: 14 days
CNS/ Disseminated: 21 days

HPP AMG Neonatal Infections 111