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Prospective randomized trial of trimethoprim/sulfamethoxazole versus pyrimethamine and sulfadiazine in the treatment of ocular toxoplasmosis.
Ophthalmology 2005; 112(11):1876-82O

Abstract

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.

DESIGN

Prospective randomized single-blind clinical trial.

PARTICIPANTS

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.

INTERVENTION

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.

MAIN OUTCOME MEASURES

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.

Authors+Show Affiliations

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.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16171866

Citation

Soheilian, Masoud, et al. "Prospective Randomized Trial of Trimethoprim/sulfamethoxazole Versus Pyrimethamine and Sulfadiazine in the Treatment of Ocular Toxoplasmosis." Ophthalmology, vol. 112, no. 11, 2005, pp. 1876-82.
Soheilian M, Sadoughi MM, Ghajarnia M, et al. Prospective randomized trial of trimethoprim/sulfamethoxazole versus pyrimethamine and sulfadiazine in the treatment of ocular toxoplasmosis. Ophthalmology. 2005;112(11):1876-82.
Soheilian, M., Sadoughi, M. M., Ghajarnia, M., Dehghan, M. H., Yazdani, S., Behboudi, H., ... Peyman, G. A. (2005). Prospective randomized trial of trimethoprim/sulfamethoxazole versus pyrimethamine and sulfadiazine in the treatment of ocular toxoplasmosis. Ophthalmology, 112(11), pp. 1876-82.
Soheilian M, et al. Prospective Randomized Trial of Trimethoprim/sulfamethoxazole Versus Pyrimethamine and Sulfadiazine in the Treatment of Ocular Toxoplasmosis. Ophthalmology. 2005;112(11):1876-82. PubMed PMID: 16171866.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prospective randomized trial of trimethoprim/sulfamethoxazole versus pyrimethamine and sulfadiazine in the treatment of ocular toxoplasmosis. AU - Soheilian,Masoud, AU - Sadoughi,Mohammad-Mehdi, AU - Ghajarnia,Mehdi, AU - Dehghan,Mohammad H, AU - Yazdani,Shahin, AU - Behboudi,Hassan, AU - Anisian,Arash, AU - Peyman,Gholam A, Y1 - 2005/09/19/ PY - 2004/10/02/received PY - 2005/05/20/accepted PY - 2005/9/21/pubmed PY - 2005/12/13/medline PY - 2005/9/21/entrez SP - 1876 EP - 82 JF - Ophthalmology JO - Ophthalmology VL - 112 IS - 11 N2 - 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. DESIGN: Prospective randomized single-blind clinical trial. PARTICIPANTS: 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. INTERVENTION: 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. MAIN OUTCOME MEASURES: 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. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/16171866/Prospective_randomized_trial_of_trimethoprim/sulfamethoxazole_versus_pyrimethamine_and_sulfadiazine_in_the_treatment_of_ocular_toxoplasmosis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(05)00887-0 DB - PRIME DP - Unbound Medicine ER -