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.
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.
Guillaume
G
Béraud
Sandrine
S
Pierre-François
Adeline
A
Foltzer
Sylvie
S
Abel
Bernard
B
Liautaud
Didier
D
Smadja
André
A
Cabié
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