Cotrimoxazole for Treatment of Cerebral Toxoplasmosis: An Observational Cohort Study during 1994-2006
Cotrimoxazole for Treatment of Cerebral Toxoplasmosis: An Observational Cohort Study during 1994-2006
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DOI：
10.4269/ajtmh.2009.80.583
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发表时间：
2009-04-01
影响因子：
3.3
通讯作者：
Cabie, Andre
中科院分区：
文献类型：
--
作者：
Beraud, Guillaume;Pierre-Francois, Sandrine;Cabie, Andre
复方新诺明（甲氧苄氨嘧啶/磺胺甲恶唑 [TMP-SMX]）是弓形虫脑炎的替代治疗方法，因为它价格便宜、耐受性良好，并且与乙胺嘧啶-磺胺嘧啶（一线药物疗法）一样有效。我们报告了一项针对接受复方新诺明治疗弓形虫脑炎的获得性免疫缺陷综合征患者的大型队列研究的结果。平均随访时间超过三年。我们的结果证实复方新诺明是有效的（85.5%），副作用发生率相对较低（22%；7.4%需要中断治疗）。首次发作后，30.1% 的患者出现复发，平均 +/- SD 为 7.8 +/- 16.2 个月。复发的唯一危险因素是治疗和/或预防依从性差。 1996年之前的死亡率显着高于1996年之后（高效抗逆转录病毒治疗的时代）（P < 0.05）。 1996 年之前接受治疗的患者中，复发率较高的趋势不显着（P = 0.06）。因此，复方新诺明可能成为治疗和预防弓形虫脑炎的一线药物方案。
Cotrimoxazole (trimethoprim/sulfamethoxazole [TMP-SMX]) is an alternative treatment for toxoplasmic encephalitis because it is inexpensive, well-tolerated, and as effective as pyrimethamine-sulfadiazine, which is the first-line drug regimen). We report results of a large cohort study of patients with acquired immunodeficiency syndrome who were treated for toxoplasmic encephalitis with cotrimoxazole. The mean follow-up period was more than three years. Our results confirm that cotrimoxazole is effective (85.5%), with a relatively low incidence of side effects (22%; 7.4% requiring treatment interruption). Relapse occurred in 30.1% of the patients at a mean +/- SD of 7.8 +/- 16.2 months after the first episode. The only risk factor for relapse was poor treatment and/or prophylaxis adherence. Mortality was significantly higher (P < 0.05) before 1996 than after 1996 (the era of highly active antiretroviral therapy). There was a non-significant trend towards a higher rate of relapse among patients treated before 1996 (P = 0.06). Consequently, cotrimoxazole could be a first-line drug regimen for curative treatment and prophylaxis of toxoplasmic encephalitis.