Skip to main content
PMC home page
Antimicrobial Agents and Chemotherapy logoLink to Antimicrobial Agents and Chemotherapy
. 1991 Oct;35(10):2049–2052. doi: 10.1128/aac.35.10.2049

Pyrimethamine-clarithromycin combination for therapy of acute Toxoplasma encephalitis in patients with AIDS.

J Fernandez-Martin 1, C Leport 1, P Morlat 1, M C Meyohas 1, J P Chauvin 1, J L Vilde 1
PMCID: PMC245324  PMID: 1836943

Abstract

Clarithromycin, a new macrolide, is effective in treating experimental Toxoplasma gondii infection. A pyrimethamine-clarithromycin combination was evaluated for the treatment of acute Toxoplasma encephalitis in 13 AIDS patients. The scheduled regimen was 2 g of clarithromycin per day and 75 mg of pyrimethamine per day for 6 weeks. The protocol was completed in eight patients and stopped in five patients (because of voluntary withdrawal by two patients, deterioration of neurological condition and thrombocytopenia in two patients, and suspicion of liver toxicity in one patient). The clinical and computed tomography scan responses at week 6 of treatment were 80 and 50%, respectively. Two patients died, one of toxoplasmic encephalitis and the other of cerebral bleeding due to pyrimethamine-induced thrombocytopenia. Adverse events related to therapy were nausea and/or vomiting (38%), skin rash (38%), significant increase of liver tests (24%), hearing loss (15%), and severe hematological abnormalities (31%). In this pilot study, a pyrimethamine-clarithromycin combination was shown to be comparable to the conventional regimen for the treatment of acute Toxoplasma encephalitis in AIDS patients.

Full text

PDF
2049

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brummett R. E., Fox K. E. Vancomycin- and erythromycin-induced hearing loss in humans. Antimicrob Agents Chemother. 1989 Jun;33(6):791–796. doi: 10.1128/aac.33.6.791. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Chang H. R., Pechère J. C. In vitro effects of four macrolides (roxithromycin, spiramycin, azithromycin [CP-62,993], and A-56268) on Toxoplasma gondii. Antimicrob Agents Chemother. 1988 Apr;32(4):524–529. doi: 10.1128/aac.32.4.524. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Chang H. R., Rudareanu F. C., Pechère J. C. Activity of A-56268 (TE-031), a new macrolide, against Toxoplasma gondii in mice. J Antimicrob Chemother. 1988 Sep;22(3):359–361. doi: 10.1093/jac/22.3.359. [DOI] [PubMed] [Google Scholar]
  4. Kohno Y., Yoshida H., Suwa T., Suga T. Comparative pharmacokinetics of clarithromycin (TE-031), a new macrolide antibiotic, and erythromycin in rats. Antimicrob Agents Chemother. 1989 May;33(5):751–756. doi: 10.1128/aac.33.5.751. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Leport C., Bastuji-Garin S., Perronne C., Salmon D., Marche C., Briçaire F., Vilde J. L. An open study of the pyrimethamine-clindamycin combination in AIDS patients with brain toxoplasmosis. J Infect Dis. 1989 Sep;160(3):557–558. doi: 10.1093/infdis/160.3.557. [DOI] [PubMed] [Google Scholar]
  6. Leport C., Raffi F., Matheron S., Katlama C., Regnier B., Saimot A. G., Marche C., Vedrenne C., Vilde J. L. Treatment of central nervous system toxoplasmosis with pyrimethamine/sulfadiazine combination in 35 patients with the acquired immunodeficiency syndrome. Efficacy of long-term continuous therapy. Am J Med. 1988 Jan;84(1):94–100. doi: 10.1016/0002-9343(88)90014-9. [DOI] [PubMed] [Google Scholar]
  7. Luft B. J., Conley F., Remington J. S., Laverdiere M., Wagner K. F., Levine J. F., Craven P. C., Strandberg D. A., File T. M., Rice N. Outbreak of central-nervous-system toxoplasmosis in western Europe and North America. Lancet. 1983 Apr 9;1(8328):781–784. doi: 10.1016/s0140-6736(83)91847-0. [DOI] [PubMed] [Google Scholar]
  8. Luft B. J., Remington J. S. AIDS commentary. Toxoplasmic encephalitis. J Infect Dis. 1988 Jan;157(1):1–6. doi: 10.1093/infdis/157.1.1. [DOI] [PubMed] [Google Scholar]
  9. Pessayre D., Larrey D., Funck-Brentano C., Benhamou J. P. Drug interactions and hepatitis produced by some macrolide antibiotics. J Antimicrob Chemother. 1985 Jul;16 (Suppl A):181–194. doi: 10.1093/jac/16.suppl_a.181. [DOI] [PubMed] [Google Scholar]
  10. Post M. J., Chan J. C., Hensley G. T., Hoffman T. A., Moskowitz L. B., Lippmann S. Toxoplasma encephalitis in Haitian adults with acquired immunodeficiency syndrome: a clinical-pathologic-CT correlation. AJR Am J Roentgenol. 1983 May;140(5):861–868. doi: 10.2214/ajr.140.5.861. [DOI] [PubMed] [Google Scholar]
  11. Wanke C., Tuazon C. U., Kovacs A., Dina T., Davis D. O., Barton N., Katz D., Lunde M., Levy C., Conley F. K. Toxoplasma encephalitis in patients with acquired immune deficiency syndrome: diagnosis and response to therapy. Am J Trop Med Hyg. 1987 May;36(3):509–516. doi: 10.4269/ajtmh.1987.36.509. [DOI] [PubMed] [Google Scholar]

Articles from Antimicrobial Agents and Chemotherapy are provided here courtesy of American Society for Microbiology (ASM)

RESOURCES