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Paper Information

Journal:   BINA   Summer 2003 , Volume 8 , Number 4 (32); Page(s) 303 To 310.
 
Paper: 

TRIMETHOPRIM-SULFAMETHOXAZOLE VS STANDARD/CLASSIC TREATMENT OF OCULAR TOXOPLASMOSIS

 
 
Author(s):  SADOUGHI M.M., SOHEYLIAN MASOUD, DEHGHAN FIROUZABADI M.H., BEHBOUDI H., SEMNANI M.A., ANISIAN A.
 
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Abstract: 

Purpose: To compare the efficacy of the standard treatment of ocular toxoplasmosis (pyrimethamine, sulfadiazine, and predinsolone) with a regimen consisting of trimethoprim sulfamethoxazole (TMP/SMX) plus predinsolone.
Methods: In a prospective randomized single-blind clinical trial, 59 patients were randomly assigned to treatment groups: 29 in the pyrimethamine/ sulfadiazine group and 30 patients to the TMP/SMX group. Treatment consisted of six weeks of antibiotics plus steroids, and patients were followed weekly with measurements of visual acuity and examination of the anterior vitreous and fundus for signs of inflammation ELISA measurements of anti- toxoplasmosis antibodies (IgM and IgG) were undertaken. The main outcome measure consisted of change in size of the retinochoroidal lesion on fundus photography, obtained at initiation and completion of treatment.
Results: No significant difference was found in the amount of decrease in retinochoroidal lesion between the two treatment groups (61% reduction in the classic treatment group ND 59% in the TMP/SMX regimen, P = 0.69). Similarly no significant difference was found in visual acuity after treatment between the two groups (mean visual acuity after treatment 0.11 Log MAR in both groups, P = 0.41). Adverse treatment effects were similar in both groups, with one patient in each suffering from any significant drug side effects. The rate of recurrence with an average of 14 months follow up was 6.8% with no significant difference between treatment groups (P = 0.48).
Conclusions: The efficacy in terms of decrease in retinal lesion and improvement in visual acuity was similar between a regimen of TMP/SMX plus steroid and the standard treatment of ocular toxoplasmosis with pyrimethamine and sulfadiazine plus steroids. Therapy with TMP/SMX appears to be an acceptable alternative for the treatment of ocular toxoplasmosis. A prospective randomized clinical trial, which would match patients in terms of size of retinal lesions, is recommended for stronger conclusion.

 
Keyword(s): OCULAR TOXOPLASMOSIS, TRIMETHOPRIM- SULFAMETHOXAZOLE, STANDARD/CLASSIC TREATMENT
 
References: 
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