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Antimicrobial Agents and Chemotherapy, June 1998, p. 1346-1349, Vol. 42, No. 6
0066-4804/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.

Randomized Trial of Trimethoprim-Sulfamethoxazole versus Pyrimethamine-Sulfadiazine for Therapy of Toxoplasmic Encephalitis in Patients with AIDS

Donato Torre,1,* Salvatore Casari,2 Filippo Speranza,1 Alessandra Donisi,2 Giampietro Gregis,2 Antonio Poggio,3 Sergio Ranieri,4 Anna Orani,5 Gioacchino Angarano,6 Francesco Chiodo,7 GianPaolo Fiori,1 Giampiero Carosi,2 and the Italian Collaborative Study Groupdagger

Department of Infectious Diseases, Regional Hospital, Varese,1 Department of Infectious Diseases, University of Brescia,2 Department of Infectious Diseases, Regional Hospital, Verbania-Pallanza,3 Department of Infectious Diseases, Regional Hospital, Ravenna,4 Department of Infectious Diseases, Regional Hospital, Lecco,5 Department of Infectious Diseases, Universtiy of Bari,6 and Department of Infectious Diseases, University of Bologna,7 Italy

Received 14 October 1997/Returned for modification 18 December 1997/Accepted 10 March 1998

The aim of the present pilot study was to compare the efficacy and safety of trimethoprim (TMP) and sulfamethoxazole (SMX) with those of the standard therapy pyrimethamine (P)-sulfadiazine (S) for the treatment of toxoplasmic encephalitis in patients with AIDS. This was a pilot, multicenter, randomized, and prospective study. Patients were randomly assigned to receive TMP (10 mg/kg of body weight/day) and SMX (50 mg/kg/day) or P (50 mg daily) and S (60 mg/kg/day) as acute therapy (for 4 weeks) and then as maintenance therapy for 3 months at half of the original dosage. Seventy-seven patients were enrolled and randomized to the study: 40 patients were treated with TMP-SMX and 37 were treated with P-S. There was no statistically significant difference in clinical efficacy during acute therapy. In contrast, patients randomized to TMP-SMX appeared more likely to achieve a complete radiologic response after acute therapy. Adverse reactions were significantly more frequent in patients treated with P-S, and skin rash was the most common adverse event noted in these patients. In conclusion, the results of the study suggest that TMP-SMX appears to be a valuable alternative to P-S, in particular in patients with opportunistic bacterial infections.

* Corresponding author. Mailing address: Department of Infectious Diseases, Regional Hospital, Viale Borri 57, 21100 Varese, Italy. Phone: 0332 278446. Fax: 39332 265586.

dagger Members of the Italian Collaborative Study Group are listed in the Appendix.

Antimicrobial Agents and Chemotherapy, June 1998, p. 1346-1349, Vol. 42, No. 6
0066-4804/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.


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