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


METHODS
Prospective randomized single-blind clinical trial.


METHODS
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.


METHODS
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.


METHODS
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.
Soheilian
Masoud
M
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@yahoo.com
Sadoughi
Mohammad-Mehdi
MM
Ghajarnia
Mehdi
M
Dehghan
Mohammad H
MH
Yazdani
Shahin
S
Behboudi
Hassan
H
Anisian
Arash
A
Peyman
Gholam A
GA
D000293:Adolescent; D000328:Adult; D000818:Animals; D000913:Antibodies, Protozoan / Q000097:blood; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D002648:Child; D002825:Chorioretinitis / Q000188:drug therapy / Q000503:physiopathology; D004359:Drug Therapy, Combination; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis; D007075:Immunoglobulin M / Q000032:analysis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011739:Pyrimethamine / Q000627:therapeutic use*; D012008:Recurrence; D016037:Single-Blind Method; D013411:Sulfadiazine / Q000627:therapeutic use*; D014122:Toxoplasma / Q000276:immunology; D014126:Toxoplasmosis, Ocular / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*; D014792:Visual Acuity
D000913:Antibodies, Protozoan; D000981:Antiprotozoal Agents; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D013411:Sulfadiazine; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D011739:Pyrimethamine