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Prospective randomized trial of trimethoprim/sulfamethoxazole versus pyrimethamine and sulfadiazine in the treatment of ocular toxoplasmosis.

AbstractOBJECTIVE:
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.
AuthorsMasoud Soheilian, Mohammad-Mehdi Sadoughi, Mehdi Ghajarnia, Mohammad H Dehghan, Shahin Yazdani, Hassan Behboudi, Arash Anisian, Gholam A Peyman
JournalOphthalmology (Ophthalmology) Vol. 112 Issue 11 Pg. 1876-82 (Nov 2005) ISSN: 1549-4713 [Electronic] United States
PMID16171866 (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
  • Sulfadiazine
  • Trimethoprim, Sulfamethoxazole Drug Combination
  • Pyrimethamine
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 Drug Combination (therapeutic use)
  • Visual Acuity

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