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Twice-weekly pyrimethamine-sulfadoxine effectively prevents Pneumocystis carinii pneumonia relapse and toxoplasmic encephalitis in patients with AIDS.

Abstract

OBJECTIVE

To evaluate the safety and efficacy of a fixed 25mg pyrimethamine--500mg sulfadoxine combination plus 15mg folinic acid given twice weekly for the prevention of relapses of Pneumocystis carinii pneumonia (PCP) and primary episodes of toxoplasmic encephalitis.

METHODS

Ninety-five HIV-infected patients with successfully treated PCP and without history of toxoplasmic encephalitis were enrolled between January 1990 and October 1995 in a single-arm open-label prospective study. No patient was receiving highly active antiretroviral treatment, including protease inhibitors or non-nucleoside reverse transcriptase inhibitors, while on study medication. Efficacy was analysed on an "as-treated" basis.

RESULTS

Five patients (5.3%) suffered a PCP relapse while on study medication, three of whom had been non-compliant. No relapse occurred in the first year. Probabilities of freedom from relapse were 0.96 after 24 months and 0.90 after 36 months. Of 69 patients positive for anti-toxoplasma IgG antibodies, one (1.5%) developed cerebral lesions compatible with toxoplasmic encephalitis after 50 months. Cutaneous allergic reactions were observed in 16 patients (16.8%) resulting in permanent discontinuation in six patients (6.3%). Two patients (2.1%) developed serious adverse reactions (Stevens-Johnson syndrome), both of whom had continued prophylaxis despite progressive hypersensitivity reactions.

CONCLUSIONS

The prophylactic regimen used is effective in preventing PCP relapses and toxoplasmic encephalitis. The regimen appears to be safe. Severe adverse events can likely be prevented by discontinuation of prophylaxis at the time allergic reactions are noted. Rechallenge frequently results in tolerance of the regimen. Efficacy and safety compare favourably with previously studied regimens. This simple prophylactic regimen may provide a convenient alternative for patients unable to tolerate approved regimens.

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  • Authors+Show Affiliations

    ,

    Department of Infectious Diseases, Charité (Campus Virchow-Klinikum), Humboldt-Universität zu Berlin, Germany.

    , , , , , , , , ,

    Source

    The Journal of infection 42:1 2001 Jan pg 8-15

    MeSH

    AIDS-Related Opportunistic Infections
    Adult
    Aged
    Anti-Infective Agents
    Cohort Studies
    Drug Combinations
    Drug Evaluation
    Drug Hypersensitivity
    Encephalitis
    Female
    Follow-Up Studies
    Humans
    Male
    Middle Aged
    Pilot Projects
    Pneumonia, Pneumocystis
    Prospective Studies
    Pyrimethamine
    Safety
    Secondary Prevention
    Sulfadoxine
    Toxoplasmosis, Cerebral

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    11243747

    Citation

    Schürmann, D, et al. "Twice-weekly Pyrimethamine-sulfadoxine Effectively Prevents Pneumocystis Carinii Pneumonia Relapse and Toxoplasmic Encephalitis in Patients With AIDS." The Journal of Infection, vol. 42, no. 1, 2001, pp. 8-15.
    Schürmann D, Bergmann F, Albrecht H, et al. Twice-weekly pyrimethamine-sulfadoxine effectively prevents Pneumocystis carinii pneumonia relapse and toxoplasmic encephalitis in patients with AIDS. J Infect. 2001;42(1):8-15.
    Schürmann, D., Bergmann, F., Albrecht, H., Padberg, J., Grünewald, T., Behnsch, M., ... Suttorp, N. (2001). Twice-weekly pyrimethamine-sulfadoxine effectively prevents Pneumocystis carinii pneumonia relapse and toxoplasmic encephalitis in patients with AIDS. The Journal of Infection, 42(1), pp. 8-15.
    Schürmann D, et al. Twice-weekly Pyrimethamine-sulfadoxine Effectively Prevents Pneumocystis Carinii Pneumonia Relapse and Toxoplasmic Encephalitis in Patients With AIDS. J Infect. 2001;42(1):8-15. PubMed PMID: 11243747.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Twice-weekly pyrimethamine-sulfadoxine effectively prevents Pneumocystis carinii pneumonia relapse and toxoplasmic encephalitis in patients with AIDS. AU - Schürmann,D, AU - Bergmann,F, AU - Albrecht,H, AU - Padberg,J, AU - Grünewald,T, AU - Behnsch,M, AU - Grobusch,M, AU - Vallée,M, AU - Wünsche,T, AU - Ruf,B, AU - Suttorp,N, PY - 2001/3/13/pubmed PY - 2001/9/21/medline PY - 2001/3/13/entrez SP - 8 EP - 15 JF - The Journal of infection JO - J. Infect. VL - 42 IS - 1 N2 - OBJECTIVE: To evaluate the safety and efficacy of a fixed 25mg pyrimethamine--500mg sulfadoxine combination plus 15mg folinic acid given twice weekly for the prevention of relapses of Pneumocystis carinii pneumonia (PCP) and primary episodes of toxoplasmic encephalitis. METHODS: Ninety-five HIV-infected patients with successfully treated PCP and without history of toxoplasmic encephalitis were enrolled between January 1990 and October 1995 in a single-arm open-label prospective study. No patient was receiving highly active antiretroviral treatment, including protease inhibitors or non-nucleoside reverse transcriptase inhibitors, while on study medication. Efficacy was analysed on an "as-treated" basis. RESULTS: Five patients (5.3%) suffered a PCP relapse while on study medication, three of whom had been non-compliant. No relapse occurred in the first year. Probabilities of freedom from relapse were 0.96 after 24 months and 0.90 after 36 months. Of 69 patients positive for anti-toxoplasma IgG antibodies, one (1.5%) developed cerebral lesions compatible with toxoplasmic encephalitis after 50 months. Cutaneous allergic reactions were observed in 16 patients (16.8%) resulting in permanent discontinuation in six patients (6.3%). Two patients (2.1%) developed serious adverse reactions (Stevens-Johnson syndrome), both of whom had continued prophylaxis despite progressive hypersensitivity reactions. CONCLUSIONS: The prophylactic regimen used is effective in preventing PCP relapses and toxoplasmic encephalitis. The regimen appears to be safe. Severe adverse events can likely be prevented by discontinuation of prophylaxis at the time allergic reactions are noted. Rechallenge frequently results in tolerance of the regimen. Efficacy and safety compare favourably with previously studied regimens. This simple prophylactic regimen may provide a convenient alternative for patients unable to tolerate approved regimens. SN - 0163-4453 UR - https://www.unboundmedicine.com/medline/citation/11243747/Twice_weekly_pyrimethamine_sulfadoxine_effectively_prevents_Pneumocystis_carinii_pneumonia_relapse_and_toxoplasmic_encephalitis_in_patients_with_AIDS_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0163-4453(00)90772-2 DB - PRIME DP - Unbound Medicine ER -