Antibiotics for human toxoplasmosis: a systematic review of randomized trials

Abstract

The efficacy of different treatment regimens in clinical syndromes of toxoplasmosis were assessed by conducting a systematic review of published randomized clinical trials through extensive searches in MEDLINE, EMBASE, and SCOPUS with no date limits, as well as manual review of journals. Outcome measures varied depending on the clinical entity of toxoplasmosis. Risk of bias was evaluated and quality of evidence was graded. Fourteen randomized trials were included of which one was a non-comparative study. One well-designed trial showed that trimethoprim-sulphamethoxazole was more effective than placebo for clinical recovery of toxoplasmic lymphadenopathy in immunocompetent hosts. For toxoplasmic encephalopathy, efficacy of pyrimethamine+sulphadiazine and trimethoprim+sulphamethoxazole were similar, whereas pyrimethamine+sulphadiazine versus pyrimathamine+clindamycin showed no difference, irrespective of the outcome. Intravitreal clindamycin+dexamethasone and conventional treatment with oral pyrimethamine+sulphadiazine had similar efficacy with regard to all outcome measures in ocular toxoplasmosis, and intravitreal therapy was found to be safe. Adverse effects seemed more common with pyrimethamine+sulphadiazine. Most trials for encephalitis and ocular manifestations had a high risk of bias and were of poor methodological quality. There were no trials evaluating drugs for toxoplasmosis in pregnancy, or for congenital toxoplasmosis. Pyrimethamine+sulphadiazine is an effective therapy for treatment of toxoplasmic encephalitis; trimethoprim+sulphamethoxazole and pyrimethamine+clindamycin are possible alternatives. Treatment with either oral or intravitreal antibiotics seems reasonable for ocular toxoplasmosis. Overall, trial evidence for the efficacy of these drugs for toxoplasmosis is poor, and further well-designed trials are needed.

A rare case of pulmonary toxoplasmosis in a patient with undifferentiated inflammatory arthritis on chronic methotrexate and corticosteroid therapy

“…First-line treatment is with sulfadiazine and pyrimethamine, administered concurrently with leucovorin to prevent folate deficiency 17. Alternate treatment regimens include clindamycin and pyrimethamine18 19 or trimethoprim–sulfamethoxazole 20.…”

Human toxoplasmosis–Searching for novel chemotherapeutics

“…Other treatment regimens include a combination of pyrimethamine with one of macrolides such as clarithromycin, roxithromycin or azithromycin, which are believed to inhibit protein synthesis. Azithromycin is able to achieve a high concentration in tissues, however, administration of any of those antibiotics may be connected with numerous adverse reactions [11,13].…”

“…However, like in the case of other chemotherapeutics, using trimethoprim and sulfamethoxazole carries a potential risk of side effects. Due to the possibility of hypersensitive reactions, administration of dapsone (diamino-diphenylsulfone) and pyrimethamine or atovaquone is Table 1 Main drugs currently used in chemotherapy of human toxoplasmosis -mechanism of their action [9,13]. recommended, as an alternative.…”

Toxoplasmose Gestacional: Uma Revisão Da Literatura

“…19,22,25,30 Sabe que a prevenção é um aspecto essencial da gestão de infecções que podem ser transmitidas da mãe para o feto durante a gravidez. 23,24,28 Apesar de ainda não existir ainda uma vacina eficaz, há outras medidas de prevenção da transmissão.…”