A prospective randomized trial of azithromycin versus trimethoprim/sulfamethoxazole in treatment of toxoplasmic retinochoroiditis

Lashay, Alireza; Mirshahi, Ahmad; Parandin, Najaf; Riazi-Esfahani, Hamid; Mazloumi, Mehdi; Lashay, Mohammad Reza; Johari, Mohammadkarim; Ashrafi, Elham

doi:10.1016/j.joco.2016.10.002

Cited by 23 publications

(27 citation statements)

References 20 publications

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“…Adverse effects were, however, more commonly reported in the pyr-sulf group. Similarly, a recent small, randomized trial of 27 patients showed equivalent efficacies of oral azithromycin (500 mg followed by 250 mg daily) plus steroids and oral TMP-SMX (160/800 mg twice daily) plus steroids in decreasing retinal lesion size, clearing vitreous inflammation, and improving visual acuity after 6 to 12 weeks of treatment (134).…”

Section: Ocular Toxoplasmosismentioning

confidence: 84%

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: 84%

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

et al. 2018

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“…Chang et al, (1988), Neville et al, (2015) and Lashay et al, (2017) showed the inhibitory effect of roxithromycin, azithromycin and spiramycin on T. gondii in-vitro 24,30,31 . The effect of macrolide antibiotics on T. gondii in-vivo and in-vitro has been investigated by researchers in numerous studies and the beneficial effect of these antibiotics in the treatment of toxoplasmosis has been proved in them.…”

Section: Discussionmentioning

confidence: 99%

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2018

IJPSR

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Toxoplasmosis is a parasitic disease with global prevalence that is caused by a unicellular organism called Toxoplasma gondii. Given the high prevalence of the disease in the country, particularly in pregnant women, and severe complications of the disease for the fetus, congenital type, the disease consequences for patients taking medications that suppress the immune system as well as side effects caused by common treatment methods, discovery of new drugs with minimal side effects seems to be necessary. In this study was an attempt to investigate the effect of tylosin on toxoplasma in-vivo environment. 200000 parasites (tachyzoite form) were subcutaneously injected to 60 Balb/C mice that were divided into 6 groups (each consisting of 10 samples). Tylosin with four different concentration levels (10-80 mg/kg) was intraperitoneally injected. One of the groups was tested without injection of medicine and another group was tested with sulfadiazine and the disease process was carefully investigated in these groups. Comparison of treatment groups with the control group and statistical analysis of data showed a significant difference in the results obtained from the use of tylosin in the groups and it was observed that the effect of tylosin on the T. gondii is dose dependent. Also any increase in the drug dose up to 80 mg/kg prolonged the survival time in the mice. The results showed that there was a significant difference between the drug dosage and the average survival time in the mice infected with T. gondii. Therefore, this drug has proved to be effective in treatment of infected mice. INTRODUCTION: T. gondii is an intracellular parasitic organism with worldwide prevalence. Warm-blooded animals such as mammals and birds are known as intermediate hosts and the family of cats serves as the final hosts of this parasite 1. The symptoms of this infection in people with normal immune system are usually mild and include fever, lymph node involvement, lethargy, and muscle pain.

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“…AZM was found to be an acceptable alternative to trimethoprim/sulfamethoxazole in terms of reducing the size of retinal lesions and improving vision. 23 Pyrimethamine and AZM in comparison with pyrimethamine and sulfadiazine were of similar efficacy, but the safety profile (frequency and severity of side effects) was significantly better in the regiment which contained AZM. 55 Likewise, the triple combination of trimethoprim/sulfamethoxazole and AZM was found safe, effective, and it seemed to hasten the resolution of inflammation.…”

Section: Toxoplasmosismentioning

confidence: 92%

An eye for azithromycin: review of the literature

et al. 2018

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Azithromycin is used widely in clinical practice and recently it is available in topical solution for ophthalmic use. The purpose of the current publication is to summarize the newest information on azithromycin’s clinical usefulness over ocular diseases. A PubMed (National Library of Medicine) and a ScienceDirect search was conducted using the key phrases ‘azithromycin’, ‘meibomian’, ‘blepharitis’, ‘trachoma’, ‘toxoplasmosis’ from 2010 to 2017. Articles were limited to articles published in English or at least having an English abstract. There were no restrictions on age, ethnicity, or geographic locations of patients. Topical azithromycin was found effective and safe in various ocular surface infections, in meibomian gland dysfunction and in trachoma. Also, it may substitute fluoroquinolones in corneal UV cross-linking. The World Health Organization targets for trachoma elimination are being reached only after 3 years of annual mass drug administration. Oral azithromycin can participate in combination regiments for toxoplasmosis, mainly because of its very good safety profile and may play a significant role in toxoplasmosis in pregnancy. Azithromycin is one of the safest antibiotics, well tolerated, and with special pharmacokinetic properties. Also, it is characterized by a broad antimicrobial spectrum. Azithromycin is efficacious for the treatment of a lot of ocular diseases and may be included as monotherapy or in combination therapy in new treatment protocols for more ocular infections. However, more research is needed to determine this.

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A prospective randomized trial of azithromycin versus trimethoprim/sulfamethoxazole in treatment of toxoplasmic retinochoroiditis

Cited by 23 publications

References 20 publications

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

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

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An eye for azithromycin: review of the literature

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