Pharmacologic Highlights

General Comments: The combination of pyrimethamine and sulfadiazine is the treatment of choice for AIDS patients with toxoplasmic encephalitis. Trimethoprim-sulfamethoxazole is effective in preventing toxoplasmosis encephalitis in AIDS patients who are at risk.

Medication or Drug Class

Dosage

Description

Rationale

Pyrimethamine Sulfonamides

75 mg PO loading dose; then 25 mg PO qd Varies with drug

Antiprotozoal

Sulfadiazine, sulfamethoxazole

Eradicates the protozoa; given together with sulfonamides; folinic acid may be given to reduce bone marrow toxicity

Eradicates the protozoa; given together with sulfonamides; folinic acid may be given to reduce bone marrow toxicity

Other Drugs: Clindamycin, azithromycin, atovaquone

Independent

Patients with toxoplasmosis do not require any special precautions to prevent the spread of infection; universal precautions are sufficient. There is no evidence that toxoplasmosis can be spread from person to person. The sensory and neurological deficits that are associated with acute disseminated toxoplasmosis present the greatest nursing challenges. Provide adequate safety measures as indicated: side rails up, bed location where the patient can be closely monitored, padding of side rails, and assistance with ambulation or activities of daily living. Reorient the patient as often as necessary, provide opportunities for undisturbed sleep, and ensure appropriate amounts of sensory stimulation. Have the patient talk about topics of interest and importance to him or her, such as hobbies, family, occupation, or current sports and news. Encourage family members to bring pictures and other items from home that help the patient focus on pleasant memories. Institute active or passive range-of-motion exercises to maintain neuromuscular function and prevent contractures. Initiate seizure precautions for patients with suspected brain involvement.

Because toxoplasmosis can affect virtually every tissue in the body, the patient often experiences pain and nausea. Choice of analgesic and antinausea agents requires close consultation with the physician, taking into consideration actual or potential neurological alterations. Non-pharmacologic pain relief methods can be instituted to augment the effect of analgesics, such as relaxation techniques, frequent repositioning to level of comfort, soothing music, and massage therapy. If vision is impaired, the patient needs assistance with activities of daily living. Everyone entering the room should identify themselves by name. Referral to social work services or community organizations for the blind may be indicated if ocular involvement is severe.

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