title: The Impact of Short-Term, Intensive Antifolate Treatment (with Pyrimethamine and Sulfadoxine) and Antibiotics Followed by Long-Term, Secondary Antifolate Prophylaxis on the Rate of Toxoplasmic Retinochoroiditis Recurrence.
abstract: To assess the impact of intensive antifolate treatment, followed by secondary antifolate prophylaxis (A-SP) on the recurrence rate of toxoplasmic retinochoroiditis (TRC). To investigate whether there are any other factors potentially predisposing for recurrence.
  
  
  
  A total of 637 medical records of TRC patients, who had been treated in the years 1994-2013 were reviewed. All patients were treated with pyrimethamine /sulfadoxine one 25mg/500mg tablet daily (P/S 25/500mg) for 21 days with a double loading dose for the first two days. From Day 2 the patients also received prednisone at a starting dose of 40mg and spiramycine 3 million IU three times daily, given for 10 days followed by azithromycin 500mg once daily for another 6 days. The analysis of the recurrence rate involved 352 patients who had completed 6-month secondary prophylaxis (P/S one 25 mg/500mg tablet twice a week).
  
  
  
  When secondary antifolate prophylaxis (A-SP) was instituted immediately after the treatment for TRC, the probability of 3-year recurrence-free survival after the first course of A-SP was 90.9%. A recurrence was most likely approximately 3.5 years after the first treatment. A univariate Cox regression model demonstrated that a risk for recurrence was 2.82 times higher (p = 0.02) in patients with retinal scars. In the multivariate analysis, the risk for recurrence was 2.41 higher (p = 0.06). In patients with haemorrhagic lesions the risk for recurrence was lower, aRR = 0.17 (approaching borderline statistical significance p = 0.08).
  
  
  
  With the institution of A-SP of immediately after the intensive treatment for TRC, i.e. when a reactivation was most likely, there was no recurrence during A-SP. Following A-SP the recurrence rates were low and recurrence-free periods tended to be longer. The treatment regimen employed had a beneficial effect on the recurrence interval as it reduced and delayed the highest probability of recurrence.
authors.affiliation: Former Department of Zoonoses and Tropical Diseases, Medical University of Warsaw, Poland, present Department of Infectious, Tropical Diseases and Hepatology, Medical University of Warsaw, Poland.
authors.forename: Piotr K
authors.initials: PK
authors.lastname: Borkowski
authors.affiliation: Department of Ophthalmology, Medical University of Warsaw, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Brydak-Godowska
authors.affiliation: Former Department of Zoonoses and Tropical Diseases, Medical University of Warsaw, Poland, present Department of Infectious, Tropical Diseases and Hepatology, Medical University of Warsaw, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Basiak
authors.affiliation: Former Department of Zoonoses and Tropical Diseases, Medical University of Warsaw, Poland, present Department of Infectious, Tropical Diseases and Hepatology, Medical University of Warsaw, Poland.
authors.forename: Karolina
authors.initials: K
authors.lastname: Świtaj
authors.affiliation: Former Department of Zoonoses and Tropical Diseases, Medical University of Warsaw, Poland, present Department of Infectious, Tropical Diseases and Hepatology, Medical University of Warsaw, Poland.
authors.forename: Hanna
authors.initials: H
authors.lastname: Żarnowska-Prymek
authors.affiliation: Former Department of Zoonoses and Tropical Diseases, Medical University of Warsaw, Poland, present Department of Infectious, Tropical Diseases and Hepatology, Medical University of Warsaw, Poland.
authors.forename: Maria
authors.initials: M
authors.lastname: Olszyńska-Krowicka
authors.affiliation: Former Department of Zoonoses and Tropical Diseases, Medical University of Warsaw, Poland, present Department of Infectious, Tropical Diseases and Hepatology, Medical University of Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Kajfasz
authors.affiliation: Department-Centre for Monitoring and Analyses of Population Health Status, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Rabczenko
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003049:Coccidiostats / Q000008:administration & dosage / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005493:Folic Acid Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use; D011739:Pyrimethamine / Q000008:administration & dosage / Q000627:therapeutic use*; D012008:Recurrence; D055502:Secondary Prevention / Q000379:methods; D015572:Spiramycin / Q000008:administration & dosage / Q000627:therapeutic use; D013413:Sulfadoxine / Q000008:administration & dosage / Q000627:therapeutic use*; D014126:Toxoplasmosis, Ocular / Q000188:drug therapy* / Q000209:etiology / Q000469:parasitology / Q000517:prevention & control*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D003049:Coccidiostats; D005493:Folic Acid Antagonists; D015572:Spiramycin; D013413:Sulfadoxine; D011241:Prednisone; D011739:Pyrimethamine