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Ce, Martinez; Zhang, D; Conway,; Ga, Peyman

doi:10.1023/a:1006129422690

Cited by 39 publications

(3 citation statements)

References 11 publications

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“…In a prospective study that compared the therapeutic efficacies of pyr-sulf plus steroids, clindamycin-sulfadiazine plus steroids, and TMP-SMX plus steroids versus an untreated control group, no regimen impacted visual acuity, the duration of inflammation, or lesion recurrence (114). Intravitreal clindamycin with steroids, on the other hand, seems to hold a promising role in OT treatment (120)(121)(122)(123). Two randomized trials demonstrated similar efficacies of intravitreal clindamycin plus steroids and pyr-sulf plus steroids in terms of improvement in visual acuity and reductions of lesion size and vitreal inflammation at specified intervals (124,125).…”

Section: Ocular Toxoplasmosismentioning

confidence: 99%

Treatment of Toxoplasmosis: Historical Perspective, Animal Models, and Current Clinical Practice

et al. 2018

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SUMMARYPrimary infection is usually subclinical, but cervical lymphadenopathy or ocular disease can be present in some patients. Active infection is characterized by tachyzoites, while tissue cysts characterize latent disease. Infection in the fetus and in immunocompromised patients can cause devastating disease. The combination of pyrimethamine and sulfadiazine (pyr-sulf), targeting the active stage of the infection, is the current gold standard for treating toxoplasmosis, but failure rates remain significant. Although other regimens are available, including pyrimethamine in combination with clindamycin, atovaquone, clarithromycin, or azithromycin or monotherapy with trimethoprim-sulfamethoxazole (TMP-SMX) or atovaquone, none have been found to be superior to pyr-sulf, and no regimen is active against the latent stage of the infection. Furthermore, the efficacy of these regimens against ocular disease remains uncertain. In multiple studies, systematic screening for infection during gestation, followed by treatment with spiramycin for acute maternal infections and with pyr-sulf for those with established fetal infection, has been shown to be effective at preventing vertical transmission and minimizing the severity of congenital toxoplasmosis (CT). Despite significant progress in treating human disease, there is a strong impetus to develop novel therapeutics for both the acute and latent forms of the infection. Here we present an overview of toxoplasmosis treatment in humans and in animal models. Additional research is needed to identify novel drugs by use of innovative high-throughput screening technologies and to improve experimental models to reflect human disease. Such advances will pave the way for lead candidates to be tested in thoroughly designed clinical trials in defined patient populations.

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Section: Ocular Toxoplasmosismentioning

confidence: 99%

Treatment of Toxoplasmosis: Historical Perspective, Animal Models, and Current Clinical Practice

et al. 2018

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“…Dr. Peyman's group then reported the resolution of inflammation and improvement in the vision following intravitreous clindamycin and dexamethasone (IVTCD) together with systemic sulfadiazine in the first trimester of pregnancy of a patient with a Toxoplasma retinochoroiditis lesion in the maculopapillary bundle [31]. Two noncomparative retrospective case series described 6 and 12 patients, respectively, with Toxoplasma retinochoroiditis that were treated with IVTCD due to intolerance, contraindication (pregnancy), or lack of response to oral medication and both reported functional and anatomic improvement [32, 33].…”

Section: Resultsmentioning

confidence: 99%

Current Treatment of Toxoplasma Retinochoroiditis: An Evidence-Based Review

Harrell

Carvounis

2014

Journal of Ophthalmology

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Objective. To perform an evidence-based review of treatments for Toxoplasma retinochoroiditis (TRC). Methods. A systematic literature search was performed using the PubMed database and the key phrase “ocular toxoplasmosis treatment” and the filter for “controlled clinical trial” and “randomized clinical trial” as well as OVID medline (1946 to May week 2 2014) using the keyword ‘‘ocular toxoplasmosis”. The included studies were used to evaluate the various treatment modalities of TRC. Results. The electronic search yielded a total of 974 publications of which 44 reported on the treatment of ocular toxoplasmosis. There were 9 randomized controlled studies and an additional 3 comparative studies on the treatment of acute TRC with systemic or intravitreous antibiotics or on reducing the recurrences of TRC. Endpoints of studies included visual acuity improvement, inflammatory response, lesion size changes, recurrences of lesions, and adverse effects of medications. Conclusions. There was conflicting evidence as to the effectiveness of systemic antibiotics for TRC. There is no evidence to support that one antibiotic regimen is superior to another so choice needs to be informed by the safety profile. Intravitreous clindamycin with dexamethasone seems to be as effective as systemic treatments. There is currently level I evidence that intermittent trimethoprim-sulfamethoxazole prevents recurrence of the disease.

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“…Indications of local therapy included intolerance to oral treatment, contraindication to systemic treatment because of pregnancy, lack of response despite systemic therapy, or combined oral and local treatment in sight-threatening cases to avoid or limit foveal or optic disc involvement ( 11 ). Martinez et al reported successful treatment of sight-threatening toxoplasmic chorioretinitis with intravitreal injection of clindamycin and dexamethasone combined with systemic sulfadiazine in a woman during the first trimester of pregnancy ( 12 ). Intravitreal steroid was not used in the current case.…”

Section: Discussionmentioning

confidence: 99%

Intravitreal Clindamycin in the Treatment of Unresponsive Zone One Toxoplasmic Chorioretinitis: A Case Report

Hosseini¹,

Abrishami²,

Zadeh³

2014

Iran Red Crescent Med J

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Introduction:The current study aimed to report a case of toxoplasma chorioretinitis resistant to standard treatments that dramatically responded to intravitreal clindamycin injection.Case Presentation:A 23-year-old woman with the diagnosis of ocular toxoplasmosis in the left eye was initially treated by oral pyrimethamine, sulfadiazine, azithromycin and oral prednisolone. Since the treatment was unsuccessful intravitreal clindamycin (1 mg/ 0.1 mL) was injected. Responding dramatically, visual acuity improved from hand motion to 20/60 and 20/20, after seven days and six weeks, respectively. Anterior chamber and vitreous reactions were resolved.Conclusions:Intravitreal injection of clindamycin may be an acceptable alternative to the classic treatment in cases with refractory ocular toxoplasmosis. It may offer the patient more convenience, a safer systemic side effect profile, greater availability, and fewer follow-up visits and hematologic evaluations. Moreover, since it responds dramatically, it would be helpful in cases with involvement of macula or closeness to the optic nerve.

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Cited by 39 publications

References 11 publications

Treatment of Toxoplasmosis: Historical Perspective, Animal Models, and Current Clinical Practice

Treatment of Toxoplasmosis: Historical Perspective, Animal Models, and Current Clinical Practice

Current Treatment of Toxoplasma Retinochoroiditis: An Evidence-Based Review

Intravitreal Clindamycin in the Treatment of Unresponsive Zone One Toxoplasmic Chorioretinitis: A Case Report

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