Béraud Guillaume, Pierre-François Sandrine, Foltzer Adeline, Abel Sylvie, Liautaud Bernard, Smadja Didier, Cabié André
Infectious Diseases Department Comité de Coordination de la Lutte Contre le Virus de l'Immunodéficience Humaine de la Martinique, Centre d'Investigation Clinique-Epidémiologique Clinique Antilles Guyane, University Hospital of Fort-de-France, France.
Am J Trop Med Hyg. 2009 Apr;80(4):583-7.
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.
复方新诺明（甲氧苄啶/磺胺甲恶唑 [TMP-SMX]）是治疗弓形虫性脑炎的替代疗法，因为它价格低廉、耐受性良好，且与一线药物疗法乙胺嘧啶-磺胺嘧啶效果相当。我们报告了一项对接受复方新诺明治疗弓形虫性脑炎的获得性免疫缺陷综合征患者的大型队列研究结果。平均随访期超过三年。我们的结果证实，复方新诺明有效（85.5%），副作用发生率相对较低（22%；7.4% 需要中断治疗）。30.1% 的患者在首次发作后平均 +/- 标准差为 7.8 +/- 16.2 个月时复发。复发的唯一风险因素是治疗和/或预防依从性差。1996 年之前的死亡率显著高于 1996 年之后（高效抗逆转录病毒治疗时代）（P < 0.05）。1996 年之前接受治疗的患者复发率有升高趋势，但无统计学意义（P = 0.06）。因此，复方新诺明可以作为治疗和预防弓形虫性脑炎的一线药物疗法。
