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The current treatment recommendations are still Clindamycin + Sulfadiazine. There has been talk of Ponazuril (the horse med) used, but there is no indication that it is more effective than Clindamycin.
Here are the current treatment recommendations:
The problem is that we lose a lot of these puppies due to myocardial infection in the heart. This makes it hard to treat effectively and get good studies. It also takes 1-2 months minimum to treat them. Sometimes longer as they can hang out in muscles and shield themselves from treatment.
If they're improving, then I would continue treatment and hopefully you can get this cleared.
We don't have anything to treat and remove the bradyzoites. This is why we can never fully cure the condition. There is always the chance of relapse. If that happens, then we go through the full Clinda/ Sulfadiazine treatment protocol again. Adding Pyrimethamine is also recommended by some.
I think I would be inclined to stop treatment after 2 months as long as the clinical signs have resolved. I would treat more based on clinical signs and getting out that 1-2 month mark vs trying to get the antibody test lower.
There's always the option to do a CSF PCR test as well to make sure the organisms are cleared from the spinal fluid. It's more invasive, but it's an option.
I think the goals just need to change from clearing the disease to symptom free. If symptom free, then we don't treat. The pups led to a diagnosis, but the overall goal is still a normal quality of life.
I'm sorry, but I don't have enough experience using Pyrimethamine to recommend a certain dose change of the Folic acid. I think I would discuss that with a pharmacologist.