Caumes E, Bocquet H, Guermonprez G, Rogeaux O, Bricaire F, Katlama C, Gentilini M
Département des Maladies Infectieuses, Parasitaires, Tropicales, et Santé Publique, Hôpital Pitié-Salpêtrière, Paris, France.
Clin Infect Dis. 1995 Sep;21(3):656-8. doi: 10.1093/clinids/21.3.656.
We assessed the value of clinical and laboratory parameters for predicting the occurrence of skin reactions induced by pyrimethamine/sulfadiazine and pyrimethamine/clindamycin and the effects of continued therapy for patients with these reactions. We retrospectively studied all episodes of toxoplasmic encephalitis in patients with AIDS who were treated with pyrimethamine/sulfadiazine or pyrimethamine/clindamycin. Eighteen (75%) of 24 patients treated with pyrimethamine/sulfadiazine had cutaneous reactions after a mean of 11 days, whereas 15 (58%) of 26 patients treated with pyrimethamine/clindamycin had cutaneous reactions after a mean of 13 days (P = .56). Nine (50%) of the 18 patients continued to be treated with pyrimethamine/sulfadiazine throughout the duration of hypersensitivity, compared with all 15 patients who were treated with pyrimethamine/clindamycin (P = .002). Nine patients had to stop therapy with pyrimethamine/sulfadiazine (two had Stevens-Johnson syndrome and one had Lyell's syndrome). Thus, treatment throughout the duration of hypersensitivity is more likely to succeed for patients receiving pyrimethamine/clindamycin, whereas therapy with pyrimethamine/sulfadiazine is associated with a high risk of Lyell's syndrome and Stevens-Johnson syndrome.
我们评估了临床和实验室参数对于预测乙胺嘧啶/磺胺嘧啶及乙胺嘧啶/克林霉素所致皮肤反应发生情况的价值，以及对出现这些反应的患者继续治疗的效果。我们回顾性研究了接受乙胺嘧啶/磺胺嘧啶或乙胺嘧啶/克林霉素治疗的艾滋病合并弓形虫脑炎患者的所有病例。接受乙胺嘧啶/磺胺嘧啶治疗的24例患者中，18例（75%）在平均11天后出现皮肤反应，而接受乙胺嘧啶/克林霉素治疗的26例患者中，15例（58%）在平均13天后出现皮肤反应（P = 0.56）。18例出现皮肤反应的患者中，9例（50%）在整个超敏反应期间继续接受乙胺嘧啶/磺胺嘧啶治疗，而接受乙胺嘧啶/克林霉素治疗的15例患者均全程接受该治疗（P = 0.002）。9例患者不得不停止乙胺嘧啶/磺胺嘧啶治疗（2例发生史蒂文斯-约翰逊综合征，1例发生中毒性表皮坏死松解症）。因此，接受乙胺嘧啶/克林霉素治疗的患者在超敏反应期间全程治疗更有可能成功，而乙胺嘧啶/磺胺嘧啶治疗与发生中毒性表皮坏死松解症和史蒂文斯-约翰逊综合征的高风险相关。
