Antibiotic treatment for ocular toxoplasmosis: a systematic review and meta-analysis: study protocol

Abstract

Background Ocular toxoplasmosis (OT) is the most common cause of posterior uveitis, leading to visual impairment in a high proportion of patients. Antibiotics and corticosteroids lower the risk of permanent visual impairment by reducing the size of the retinochoroidal scar, the risk of recurrence, and the severity and duration of acute symptoms. Although OT is a very common cause of infectious posterior uveitis, its treatment remains controversial. Through our systematic review and meta-analysis, we aim to provide the best possible evidence-based information on the safety and effectiveness of the different antibiotic regimes for OT. Methods This systematic review protocol has been developed based on PRISMA-P guidelines for reporting systematic reviews evaluating health care interventions. We will include all published and unpublished randomized controlled trials (RCTs) comparing different antibiotics used for the treatment of OT. We will consider changes in visual acuity, number of recurrences, improvement or worsening of ocular inflammation, size of lesion, and adverse effects as our outcomes. Screening, data extraction, and quality assessment will be undertaken by two reviewers with disagreements resolved through discussion. Studies that compared antibiotics with placebo will be excluded. The reviews will be assessed for quality and relevance. We will assess the risk of bias in five domains according to Cochrane group’s tool. The type of data will dictate measures of treatment effect. We will use a random-effects model to calculate our meta-analysis, as eligible studies represent clinically varied populations of participants. Discussion The strength of our study will lie in the exhaustive and systematic nature of the literature search, as well as in its methods for assessing quality and analyzing RCT data. Considering the controversial efficacy of the treatment for OT, our study will contribute to improving the existing evidence on the effectiveness of different antibiotics. Future studies may be conducted to increase physicians’ awareness of antibiotic therapies, improving the health of patients with OT. Systematic review registration PROSPERO CRD42018085468. Electronic supplementary material The online version of this article (10.1186/s13643-019-1067-8) contains supplementary material, which is available to authorized users.

Safety and efficacy of different antibiotic regimens in patients with ocular toxoplasmosis: systematic review and meta-analysis

“…Primary outcome measures were changes in visual acuity at least three months after the start of treatment and the number of recurrences at the end of follow-up. Secondary outcome measures included the behavior of ocular inflammation signs according to the Standardization of Uveitis Nomenclature (SUN), size of lesion at the end of the follow-up, adverse drug reactions, and duration of the active lesion, as stated in the study protocol [21].…”

“…The study protocol was developed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) guidelines [20], and it was previously published in 2019 [21]. In the same way, it was registered in PROSPERO, with the registration number CRD42018085468 [22].…”

“…We assessed statistical heterogeneity in each meta-analysis using the I 2 statistic. Additional information about the methodology is presented in the published protocol [21].…”

“…Most primary outcomes established in the study protocol were not settled in the articles found by the search strategy; thus, secondary outcomes were considered for the quantitative analysis [21]. In addition, missing data and supplementary material were requested from some authors; however, they did not respond or did not have access to those data.…”

The challenges of treating a patient with recurrent congenital toxoplasmic chorioretinitis

“…[4]. Antibiotics and corticosteroids do not eliminate the presence of the parasite, but they reduce the size of retinochoroidal scar, the possibility of recurrence, and the length of the acute infectious period [9]. The classic treatment is "triple-drug therapy", which consists of pyrimethamine, sulfadiazine, and corticosteroids.…”