Table 2

Drug treatment regimens for the common CNS infections

InfectionSide effects
Stopping maintenance may be considered if after HAART is started the CD4 count remains above 200/mm3 for over four months.
Toxoplasmosis
Acute phase (for 6 weeks)
First line treatment:
Pyrimethamine loading dose (100 mg orally for 3 days, then 75 mg/day)Marrow suppression
+
Sulfadiazine 6–8 g/day orally/ivRash, nephrotoxicity, marrow suppression
+
Folinic acid 15 mg/day
Second line treatment:
Clindamycin 600–900 mg/day by mouth/iv instead of sulfadiazineRash, diarrhoea
Maintenance treatment
Pyrimethamine 25–50 mg/day
+
Sulfadiazine 2–4 g/day
+
Folinic acid 10 mg/day
Clindamycin 600 mg/day instead of sulfadiazine
Cryptococcal meningitis
Acute phase treatment for 4–6 weeks or until CSF culture negative
Amphotericin B 0.7–1.0 mg/kg/day (via central line)Nephrotoxicity, anaemia, hepatitis, marrow suppression
Flucytosine 100–150 mg/kg/day orally
In milder cases
Fluconazole 400 mg iv/orallyRash, hepatitis
Maintenance treatment
Fluconazole 200–400 mg/day orally