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

Abstract

Background Ocular toxoplasmosis (OT) is the most common cause of posterior uveitis, which leads to visual impairment in a large proportion of patients. Antibiotics and corticosteroids lower the risk of permanent visual loss by controlling infection and inflammation. However, there remains disagreement regarding optimal antibiotic therapy for OT. Therefore, this systematic review and meta-analysis were performed to determine the effects and safety of existing antibiotic treatment regimens for OT. Methods MEDLINE, EMBASE, The Cochrane Central Register of Controlled Trials, LILACS, WHO International Clinical Trials Registry Platform portal, ClinicalTrials.gov, and Gray Literature in Europe (“OpenGrey”) were searched for relevant studies; manual searches of reference lists were performed for studies identified by other methods. All published and unpublished randomized controlled trials that compared antibiotic schemes known to be effective in OT at any dosage, duration, and administration route were included. Studies comparing antibiotics with placebo were excluded. This review followed standard methodological procedures recommended by the Cochrane group. Results Ten studies were included in the narrative summary, of which four were included for quantitative synthesis (meta-analysis). Interventions were organized into three groups: intravitreal clindamycin versus pyrimethamine + sulfadiazine, trimethoprim + sulfamethoxazole versus other antibiotics, and other interventions. The first comparison favored intravitreal clindamycin (Mean difference (MD) = 0.10 logMAR; 95% confidence interval = 0.01 to 0.22). However, this finding lacks clinical relevance. Other outcomes showed no statistically significant differences between the treatment groups. In general, the risk of performance bias was high in evaluated studies, and the quality of the evidence found was low to very low. Conclusions No antibiotic scheme was superior to others, and the selection of a treatment regimen depends on multiple factors; therefore, treatment should be chosen based on safety, sulfa allergies, and availability.

Clinical outcomes of intravitreal treatment for ocular toxoplasmosis: systematic review and meta-analysis

“…Over the last few years, systematic reviews and meta-analyses have described the clinical effectiveness of anti-toxoplasma therapies based on therapeutic approaches and current treatments 6 , 22 , 67 , 73 - 77 . In a systematic review, Jasper et al reported treatment outcomes following antiparasitic therapy with or without systemic corticosteroids 6 .…”

Diagnostik und Behandlung der okulären Toxoplasmose

“…Warum das so ist, lässt sich nur spekulieren. Sicherlich spielen aber nach wie vor der fehlende Nachweis der Antibiotikawirkung auf die funktionellen Endergebnisse und die Kenntnis der Verträglichkeit und der Nebenwirkungen eine entscheidende Rolle [5,7]. Andererseits sehen wir einen klaren Trend in Richtung einer zunehmenden Akzeptanz von TMP/SMZ.…”

“…Es wird immer wieder berichtet, dass einzelne Patienten auf die primär verord- nete Therapie nicht adäquat ansprechen [3,5,7] Nur in Ausnahmefällen wird die intravitreale Injektion als therapeutische Option erwogen [16]. Dies ist in Anbetracht der Pathophysiologie der Erkrankung sinnvoll und steht in Einklang mit vergleichbaren Erhebungen, die dies als selektives Verfahren ansehen [3,21].…”

Optical Coherence Tomography Angiography Findings in Ocular Toxoplasmosis with Multiple Recurrences

“…Ocular toxoplasmosis represents the leading cause of posterior uveitis worldwide, 1 with the highest incidence reported in Brazil was 20%. 2 In immunocompetent individuals, ocular toxoplasmosis is responsible for 30–50% of all cases of posterior uveitis.…”