Adverse cutaneous reactions to pyrimethamine/sulfadiazine and pyrimethamine/clindamycin in patients with AIDS and toxoplasmic encephalitis.
We assessed the value of clinical and laboratory parameters for predicting the occurrence of skin reactions induced by pyrimethamine/sulfadiazine and pyrimethamine/clindamycin and the effects of continued therapy for patients with these reactions. We retrospectively studied all episodes of toxoplasmic encephalitis in patients with AIDS who were treated with pyrimethamine/sulfadiazine or pyrimethamine/clindamycin. Eighteen (75%) of 24 patients treated with pyrimethamine/sulfadiazine had cutaneous reactions after a mean of 11 days, whereas 15 (58%) of 26 patients treated with pyrimethamine/clindamycin had cutaneous reactions after a mean of 13 days (P = .56). Nine (50%) of the 18 patients continued to be treated with pyrimethamine/sulfadiazine throughout the duration of hypersensitivity, compared with all 15 patients who were treated with pyrimethamine/clindamycin (P = .002). Nine patients had to stop therapy with pyrimethamine/sulfadiazine (two had Stevens-Johnson syndrome and one had Lyell's syndrome). Thus, treatment throughout the duration of hypersensitivity is more likely to succeed for patients receiving pyrimethamine/clindamycin, whereas therapy with pyrimethamine/sulfadiazine is associated with a high risk of Lyell's syndrome and Stevens-Johnson syndrome.
Département des Maladies Infectieuses, Parasitaires, Tropicales, et Santé Publique, Hôpital Pitié-Salpêtrière, Paris, France.
E
E
Caumes
H
H
Bocquet
G
G
Guermonprez
O
O
Rogeaux
F
F
Bricaire
C
C
Katlama
M
M
Gentilini
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000009:adverse effects; D002981:Clindamycin / Q000008:administration & dosage / Q000009:adverse effects*; D003875:Drug Eruptions / Q000209:etiology*; D004359:Drug Therapy, Combination; D004660:Encephalitis / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011739:Pyrimethamine / Q000008:administration & dosage / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D013262:Stevens-Johnson Syndrome / Q000209:etiology; D013411:Sulfadiazine / Q000008:administration & dosage / Q000009:adverse effects*; D016781:Toxoplasmosis, Cerebral / Q000150:complications* / Q000188:drug therapy*
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D013411:Sulfadiazine; D002981:Clindamycin; D011739:Pyrimethamine