| Abstract | OBJECTIVE: To compare the efficacy of the classic treatment of ocular toxoplasmosis (pyrimethamine, sulfadiazine, and prednisolone) with a regimen consisting of trimethoprim/sulfamethoxazole (co-trimoxazole) plus prednisolone. DESIGN: Prospective randomized single-blind clinical trial. PARTICIPANTS: Fifty-nine patients with active ocular toxoplasmosis were randomly assigned to 2 treatment groups: 29 were treated with pyrimethamine/sulfadiazine, and 30 patients received trimethoprim/sulfamethoxazole. INTERVENTION: Treatment consisted of 6 weeks' treatment with antibiotics plus steroids. Antitoxoplasmosis antibodies (immunoglobulin M [IgM] and IgG) were measured using an enzyme-linked immunosorbent assay. MAIN OUTCOME MEASURES: Changes in retinochoroidal lesion size after 6 weeks' treatment, visual acuity (VA) before and after intervention, adverse drug reactions during follow-up, and rate of recurrence. RESULTS: Active toxoplasmosis retinochoroiditis resolved in all patients over 6 weeks' treatment, with no significant difference in mean reduction of retinochoroidal lesion size between the 2 treatment groups (61% reduction in the classic treatment group and 59% in the trimethoprim/sulfamethoxazole group, P = 0.75). Similarly, no significant difference was found in VA after treatment between the 2 groups (mean VAs after treatment were 0.12 logarithm of the minimum angle of resolution [logMAR] [20/25] in the classic treatment group and 0.09 logMAR [20/25] in the trimethoprim/sulfamethoxazole group, P = 0.56). Adverse effects were similar in both groups, with one patient in each suffering from any significant drug side effects. The overall recurrence rate after 24 months' follow-up was 10.16%, with no significant difference between the treatment groups (P = 0.64). CONCLUSIONS: Drug efficacies in terms of reduction in retinal lesion size and improvement in VA were similar in a regimen of trimethoprim/sulfamethoxazole and the classic treatment of ocular toxoplasmosis with pyrimethamine and sulfadiazine. Therapy with trimethoprim/sulfamethoxazole seems to be an acceptable alternative for the treatment of ocular toxoplasmosis. |
| Authors | Masoud Soheilian, Mohammad-Mehdi Sadoughi, Mehdi Ghajarnia, Mohammad H Dehghan, Shahin Yazdani, Hassan Behboudi, Arash Anisian, Gholam A Peyman
(Affiliation: Ocular Inflammatory and Uveitis Service, Department of Ophthalmology, and Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. masoud_soheilian at yahoo.com)
|
| Journal | Ophthalmology
(Ophthalmology)
Vol. 112
Issue 11
Pg. 1876-82
(Nov 2005)
ISSN: 1549-4713 United States |
| PMID | 16171866
(Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
|
| Chemical References |
- Antibodies, Protozoan
- Antiprotozoal Agents
- Immunoglobulin G
- Immunoglobulin M
- Pyrimethamine
- Sulfadiazine
- Trimethoprim-Sulfamethoxazole Combination
|
| Topics |
- Adolescent
- Adult
- Animals
- Antibodies, Protozoan
(blood)
- Antiprotozoal Agents
(therapeutic use)
- Child
- Chorioretinitis
(drug therapy, physiopathology)
- Drug Therapy, Combination
- Enzyme-Linked Immunosorbent Assay
- Female
- Humans
- Immunoglobulin G
(analysis)
- Immunoglobulin M
(analysis)
- Male
- Middle Aged
- Prospective Studies
- Pyrimethamine
(therapeutic use)
- Recurrence
- Single-Blind Method
- Sulfadiazine
(therapeutic use)
- Toxoplasma
(immunology)
- Toxoplasmosis, Ocular
(drug therapy, physiopathology)
- Treatment Outcome
- Trimethoprim-Sulfamethoxazole Combination
(therapeutic use)
- Visual Acuity
|
