社團法人臺灣臨床藥學會

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【案例報告】Pyrimethamine 合併Trimethoprim-Sulfamethoxazole治療先天性弓形蟲感染症於12天早產兒男嬰之案例分享
Pyrimethamine and Trimethoprim-Sulfamethoxazole for Congenital Toxoplasmosis Treatment in a 12-Day-Old Preterm Boy: A Case Report
先天性弓形蟲感染症,治療,Pyrimethamine,Trimethoprim-Sulfamethoxazole、Congenital Toxoplasmosis, Treatment
楊涵絢Han-Shun Yang1,*
1馬偕紀念醫院淡水院區藥劑科
先天性弓形蟲通常是懷孕婦女在懷孕期間急性感染的結果,寄生蟲可經由胎盤傳 染給胎兒,造成視網膜脈絡炎、水腦症、大腦鈣化、心智發育遲緩、癲癇等後果。首 選建議藥物組合包括 pyrimethamine 加上 sulfadiazine 及 leucovorin 三者的組合。本案 例原使用第一線治療組合—pyrimethamine 加上sulfadiazine 及 leucovorin,治療2 個月後面臨無sulfadiazine 可使用。Trimethoprim-sulfamethoxazole 與 sulfadiazine 有 相似的作用機轉,排除 glucose-6-phosphate deficiency (G6PD) 缺乏症,trimethoprimsulfamethoxazole 為替代 sulfadiazine 的選擇。目前對於先天性弓蟲症的治療建議大都 是來自案例報告的結果,仍缺乏實證的支持。藥物的選擇依不同區域及不同的臨床經 驗而會有不同的治療計畫。本案例治療經驗為少數特殊之情形,可提供本土在治療先 天性弓蟲症的另一參考。
 
ABSTRACT 
 
Toxoplasmosis gondii can be transmitted to the fetus if infection occurs during pregnancy, resulting in congenital toxoplasmosis in the baby. Chorioretinitis, intracranial calcifications, and hydrocephalus are major clinical signs. The combination of pyrimethamine plus sulfadiazine with leucovorin is the most widely recommended regimen. In our case, after two months of the treatment protocol, there was a shortage of sulfadiazine. Since the mechanism of trimethoprimsulfamethoxazole (TMP-SMX) is similar to sulfadiazine, without glucose-6-phosphate deficiency (G6PD), the alternative treatment for the case was TMP-SMX. Despite treatment protocols are not standardized, variation in the drug availability and the experience of centers, our case may provide another reference for the local practice. 
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