比较螺旋霉素与乙胺嘧啶/磺胺嘧啶治疗妊娠弓形虫病的不良反应：对于胎儿未证实的感染，螺旋霉素真的是首选药物吗？

Comparison of adverse reactions of spiramycin versus pyrimethamine/sulfadiazine treatment of toxoplasmosis in pregnancy: is spiramycin really the drug of choice for unproven infection of the fetus?

机构信息

Department of Infectious Diseases, Charles University, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic.

Department of Epidemiology, University of Defence, Faculty of Military Health Sciences, Hradec Kralove, Czech Republic.

出版信息

J Matern Fetal Neonatal Med. 2023 Dec;36(1):2215377. doi: 10.1080/14767058.2023.2215377.

DOI:10.1080/14767058.2023.2215377

PMID:37217458

Abstract

BACKGROUND

Therapeutic regimens for the treatment of toxoplasmosis are not standardized. Treatment strategy mainly at the end of the second and the beginning of the third trimester, especially in cases of negative prenatal diagnosis, is the least uniform. In some situations, the choice of treatment may be ambiguous, and adverse drug reactions of the therapy should be taken into consideration.

METHODS

Adverse drug reactions of anti-toxoplasma therapy with spiramycin ( = 77) versus pyrimethamine/sulfadiazine ( = 35) were compared in 112 pregnant women.

RESULTS

Up to 36.6% of women reported adverse reactions to the treatment overall ( = 41). Out of those 38.9% ( = 30) were treated with spiramycin and 31.4% ( = 11) with pyrimethamine/sulfadiazine. Toxic allergic reactions were the only indication for discontinuation of treatment in 8.9% of patients ( = 10), where 9.1% ( = 7) were reported in spiramycin and 8.6% ( = 3) in pyrimethamine/sulfadiazine cohort. Neurotoxic complications (acral paraesthesia) were significantly more frequent during the therapy with spiramycine in 19.5% ( = 15) compared to no cases in pyrimethamine/sulfadiazine group ( = .003). Other adverse drug reactions, such as gastrointestinal discomfort, nephrotoxicity, vaginal discomfort were reported, but the differences between the cohorts were not significant.

CONCLUSIONS

The superiority of one of the therapeutic regimens was not statistically demonstrated, since the differences in overall toxicity or incidence of toxic allergic reactions between the cohorts were not confirmed ( = .53 and = 1.00, respectively). However, although the isolated neurotoxicity of spiramycin was the only significant adverse reaction demonstrated in this study, pyrimethamine/sulfadiazine therapy should be preferred, because it is known to be more effective and with limited adverse reactions.

摘要

背景

治疗弓形虫病的治疗方案尚未标准化。治疗策略主要在妊娠第 2 期末和第 3 期初，尤其是在产前诊断为阴性的情况下，最不统一。在某些情况下，治疗的选择可能存在歧义，并且应考虑治疗的药物不良反应。

方法

比较了螺旋霉素（ = 77）与乙胺嘧啶/磺胺嘧啶（ = 35）治疗弓形虫病的药物不良反应，纳入了 112 名孕妇。

结果

总体而言，有 36.6%的女性报告了治疗不良反应（ = 41）。其中 38.9%（ = 30）接受了螺旋霉素治疗，31.4%（ = 11）接受了乙胺嘧啶/磺胺嘧啶治疗。仅 8.9%的患者（ = 10）因毒性过敏反应而停止治疗，其中 9.1%（ = 7）发生在螺旋霉素组，8.6%（ = 3）发生在乙胺嘧啶/磺胺嘧啶组。与乙胺嘧啶/磺胺嘧啶组相比，螺旋霉素治疗组的神经毒性并发症（肢端感觉异常）发生率明显更高，为 19.5%（ = 15），而乙胺嘧啶/磺胺嘧啶组无此类病例（ = .003）。其他药物不良反应，如胃肠道不适、肾毒性、阴道不适也有报道，但两组间差异无统计学意义。