Cotrimoxazole therapy ofToxoplasma gondii encephalitis in AIDS patients

Abstract

Twenty-four consecutive HIV-positive patients affected by Toxoplasma gondii encephalitis received trimethoprim-sulfamethoxazole (cotrimoxazole) as acute-phase treatment. Two dosage regimens of cotrimoxazole were used: 40 mg/kg/day (12 patients) or 120 mg/kg/day (12 patients) of total compound (trimethoprim plus sulfamethoxazole). Clinical and radiological responses to treatment were evaluated, and the product-limit method for survival data analysis was used. Eighteen of 24 patients showed both a clinical and radiological response (75% response rate). There were no differences in response rates between patients receiving the two dosage regimens of cotrimoxazole. Adverse reaction consisted of leukopenia (two cases) and skin rash (three cases) which led to the discontinuation of the drug in one case. These results suggest that a randomized, controlled clinical trial should be carried out comparing cotrimoxazole versus sulfadiazine-pyrimethamine in AIDS patients with Toxoplasma gondii encephalitis.

Toxoplasmosis in HIV/AIDS Patients - A Living Legacy

“…This standard combination has been successfully used in treating CT but has been associated with high toxicities such as Lyell's syndrome or Steven-Johnson syndrome (Katlama et al, 1996a;Torre et al, 1998). The other regimen is trimethoprim/sulfamethoxazole (Co-trimoxazole, 5/25 mg/kg PO or intravenous (IV) every 12 h for 4-6 weeks) (Canessa et al, 1992). This therapeutic regimen has been confirmed for its efficacy and safety in a single available randomized clinical trial (Canessa et al, 1992;Torre et al, 1998;Dedicoat & Livesley, 2006;Béraud et al, 2009).…”

“…The other regimen is trimethoprim/sulfamethoxazole (Co-trimoxazole, 5/25 mg/kg PO or intravenous (IV) every 12 h for 4-6 weeks) (Canessa et al, 1992). This therapeutic regimen has been confirmed for its efficacy and safety in a single available randomized clinical trial (Canessa et al, 1992;Torre et al, 1998;Dedicoat & Livesley, 2006;Béraud et al, 2009). Several alternative therapies, principally used in patients who are intolerant to this combination, have been reported to be effective, including clindamycin and pyrimethamine or sulfadiazine (Katlama et al, 1996a;Tsai et al, 2002), clarithromycin and pyrimethamine (Fernandez-Martin et al, 1991), clindamycin and 5-fluoro-uracil (Dhiver et al, 1993), azithromycin and pyrimethamine (Saba et al, 1993;Jacobson et al, 2001), clindamycin and fansidar (Nissapatorn et al, 2004), sulfadoxine and pyrimethamine (Amogne et al, 2006), and atovaquone (Torres et al, 1997).…”

Evidence-based practice: Management of Combined Toxoplasma meningo-encephalitis and Pneumocystis pneumonia in HIV

“…One small case series reported by Canessa et al demonstrated effectivity of co-trimoxazole alone. 8 The evidence for effectiveness of this regime in severe disease is limited. These regimens have been recommended when standard therapy not tolerated.…”

Prevención de las infecciones oportunistas en pacientes adultos y adolescentes infectados por el VIH. Recomendaciones de GESIDA/Plan Nacional sobre el Sida. Año 2003

“…En estos enfermos se recomienda mantener el tratamiento con el fármaco que se ha usado en la fase aguda: pirimetamina sola o asociada a atovaquona, azitromicina, minociclina o doxicilina, 5-fluorouracilo y clindamicina, y minociclina o doxicilina con sulfadiazina. Igualmente existe muy poca experiencia con dapsona y pirimetamina o con cotrimoxazol 123,[125][126][127][128][129][130][131][132][133][134][135][136][137][138][139][140][141][142] (CII). También se ha utilizado claritromicina (1 g/12 h) en lugar de azitromicina, pero no se recomienda dado que la claritromicina a esas dosis se asociara a un exceso de mortalidad en un estudio de profilaxis frente al MAC 143 .…”