Soheilian Masoud, Sadoughi Mohammad-Mehdi, Ghajarnia Mehdi, Dehghan Mohammad H, Yazdani Shahin, Behboudi Hassan, Anisian Arash, Peyman Gholam A
Ocular Inflammatory and Uveitis Service, Department of Ophthalmology, and Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Ophthalmology. 2005 Nov;112(11):1876-82. doi: 10.1016/j.ophtha.2005.05.025. Epub 2005 Sep 19.
To compare the efficacy of the classic treatment of ocular toxoplasmosis (pyrimethamine, sulfadiazine, and prednisolone) with a regimen consisting of trimethoprim/sulfamethoxazole (co-trimoxazole) plus prednisolone.
Prospective randomized single-blind clinical trial.
Fifty-nine patients with active ocular toxoplasmosis were randomly assigned to 2 treatment groups: 29 were treated with pyrimethamine/sulfadiazine, and 30 patients received trimethoprim/sulfamethoxazole.
Treatment consisted of 6 weeks' treatment with antibiotics plus steroids. Antitoxoplasmosis antibodies (immunoglobulin M [IgM] and IgG) were measured using an enzyme-linked immunosorbent assay.
Changes in retinochoroidal lesion size after 6 weeks' treatment, visual acuity (VA) before and after intervention, adverse drug reactions during follow-up, and rate of recurrence.
Active toxoplasmosis retinochoroiditis resolved in all patients over 6 weeks' treatment, with no significant difference in mean reduction of retinochoroidal lesion size between the 2 treatment groups (61% reduction in the classic treatment group and 59% in the trimethoprim/sulfamethoxazole group, P = 0.75). Similarly, no significant difference was found in VA after treatment between the 2 groups (mean VAs after treatment were 0.12 logarithm of the minimum angle of resolution [logMAR] [20/25] in the classic treatment group and 0.09 logMAR [20/25] in the trimethoprim/sulfamethoxazole group, P = 0.56). Adverse effects were similar in both groups, with one patient in each suffering from any significant drug side effects. The overall recurrence rate after 24 months' follow-up was 10.16%, with no significant difference between the treatment groups (P = 0.64).
Drug efficacies in terms of reduction in retinal lesion size and improvement in VA were similar in a regimen of trimethoprim/sulfamethoxazole and the classic treatment of ocular toxoplasmosis with pyrimethamine and sulfadiazine. Therapy with trimethoprim/sulfamethoxazole seems to be an acceptable alternative for the treatment of ocular toxoplasmosis.
比较眼部弓形虫病的经典治疗方案(乙胺嘧啶、磺胺嘧啶和泼尼松龙)与由甲氧苄啶/磺胺甲恶唑(复方新诺明)加泼尼松龙组成的治疗方案的疗效。
前瞻性随机单盲临床试验。
59例活动性眼部弓形虫病患者被随机分为2个治疗组:29例接受乙胺嘧啶/磺胺嘧啶治疗,30例接受甲氧苄啶/磺胺甲恶唑治疗。
治疗包括使用抗生素加类固醇进行6周治疗。使用酶联免疫吸附测定法检测抗弓形虫抗体(免疫球蛋白M [IgM]和IgG)。
6周治疗后视网膜脉络膜病变大小的变化、干预前后的视力(VA)、随访期间的药物不良反应以及复发率。
在6周的治疗中,所有患者的活动性弓形虫性视网膜脉络膜炎均得到缓解,两个治疗组之间视网膜脉络膜病变大小的平均缩小率无显著差异(经典治疗组缩小61%,甲氧苄啶/磺胺甲恶唑组缩小59%,P = 0.75)。同样,两组治疗后的视力也无显著差异(经典治疗组治疗后的平均视力为最小分辨角对数[logMAR] 0.12 [20/25],甲氧苄啶/磺胺甲恶唑组为0.09 logMAR [20/25],P = 0.56)。两组的不良反应相似,每组各有1例出现任何显著的药物副作用。24个月随访后的总复发率为10.16%,治疗组之间无显著差异(P = 0.64)。
在视网膜病变大小缩小和视力改善方面,甲氧苄啶/磺胺甲恶唑治疗方案与眼部弓形虫病的经典乙胺嘧啶和磺胺嘧啶治疗方案的疗效相似。甲氧苄啶/磺胺甲恶唑治疗似乎是治疗眼部弓形虫病的一种可接受的替代方案。