title: Randomized trial of trimethoprim-sulfamethoxazole versus pyrimethamine-sulfadiazine for therapy of toxoplasmic encephalitis in patients with AIDS. Italian Collaborative Study Group.
abstract: The aim of the present pilot study was to compare the efficacy and safety of trimethoprim (TMP) and sulfamethoxazole (SMX) with those of the standard therapy pyrimethamine (P)-sulfadiazine (S) for the treatment of toxoplasmic encephalitis in patients with AIDS. This was a pilot, multicenter, randomized, and prospective study. Patients were randomly assigned to receive TMP (10 mg/kg of body weight/day) and SMX (50 mg/kg/day) or P (50 mg daily) and S (60 mg/kg/day) as acute therapy (for 4 weeks) and then as maintenance therapy for 3 months at half of the original dosage. Seventy-seven patients were enrolled and randomized to the study: 40 patients were treated with TMP-SMX and 37 were treated with P-S. There was no statistically significant difference in clinical efficacy during acute therapy. In contrast, patients randomized to TMP-SMX appeared more likely to achieve a complete radiologic response after acute therapy. Adverse reactions were significantly more frequent in patients treated with P-S, and skin rash was the most common adverse event noted in these patients. In conclusion, the results of the study suggest that TMP-SMX appears to be a valuable alternative to P-S, in particular in patients with opportunistic bacterial infections.
authors.affiliation: Department of Infectious Diseases, Regional Hospital, Varese, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Torre
authors.forename: S
authors.initials: S
authors.lastname: Casari
authors.forename: F
authors.initials: F
authors.lastname: Speranza
authors.forename: A
authors.initials: A
authors.lastname: Donisi
authors.forename: G
authors.initials: G
authors.lastname: Gregis
authors.forename: A
authors.initials: A
authors.lastname: Poggio
authors.forename: S
authors.initials: S
authors.lastname: Ranieri
authors.forename: A
authors.initials: A
authors.lastname: Orani
authors.forename: G
authors.initials: G
authors.lastname: Angarano
authors.forename: F
authors.initials: F
authors.lastname: Chiodo
authors.forename: G
authors.initials: G
authors.lastname: Fiori
authors.forename: G
authors.initials: G
authors.lastname: Carosi
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000469:parasitology; D000328:Adult; D000818:Animals; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004660:Encephalitis / Q000188:drug therapy* / Q000469:parasitology; D005260:Female; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D011739:Pyrimethamine / Q000008:administration & dosage / Q000009:adverse effects; D013411:Sulfadiazine / Q000008:administration & dosage / Q000009:adverse effects; D014122:Toxoplasma / Q000187:drug effects*; D014123:Toxoplasmosis / Q000188:drug therapy*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000890:Anti-Infective Agents; D013411:Sulfadiazine; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D011739:Pyrimethamine