Cotrimoxazole for treatment of cerebral toxoplasmosis: an observational cohort study during 1994-2006.
Cotrimoxazole (trimethoprim/sulfamethoxazole [TMP-SMX]) is an alternative treatment for toxoplasmic encephalitis because it is inexpensive, well-tolerated, and as effective as pyrimethamine-sulfadiazine, which is the first-line drug regimen). We report results of a large cohort study of patients with acquired immunodeficiency syndrome who were treated for toxoplasmic encephalitis with cotrimoxazole. The mean follow-up period was more than three years. Our results confirm that cotrimoxazole is effective (85.5%), with a relatively low incidence of side effects (22%; 7.4% requiring treatment interruption). Relapse occurred in 30.1% of the patients at a mean +/- SD of 7.8 +/- 16.2 months after the first episode. The only risk factor for relapse was poor treatment and/or prophylaxis adherence. Mortality was significantly higher (P < 0.05) before 1996 than after 1996 (the era of highly active antiretroviral therapy). There was a non-significant trend towards a higher rate of relapse among patients treated before 1996 (P = 0.06). Consequently, cotrimoxazole could be a first-line drug regimen for curative treatment and prophylaxis of toxoplasmic encephalitis.
Béraud
Guillaume
G
Infectious Diseases Department Comité de Coordination de la Lutte Contre le Virus de l'Immunodéficience Humaine de la Martinique, Centre d'Investigation Clinique-Epidémiologique Clinique Antilles Guyane, University Hospital of Fort-de-France, France.
Pierre-François
Sandrine
S
Foltzer
Adeline
A
Abel
Sylvie
S
Liautaud
Bernard
B
Smadja
Didier
D
Cabié
André
A
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D016781:Toxoplasmosis, Cerebral / Q000150:complications / Q000188:drug therapy*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000627:therapeutic use*
D019380:Anti-HIV Agents; D000981:Antiprotozoal Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination