  
Azithromycin plus pyrimethamine a possible option for HIV-related toxoplasmosis
Last Updated: 2001-04-30 15:11:41 EDT (Reuters Health)
WESTPORT, CT (Reuters Health) - Although adverse events are common, a combination of azithromycin and pyrimethamine may be a successful alternative therapy for AIDS patients with toxoplasmic encephalitis who cannot tolerate standard treatment, according the results of a phase I/II dose-escalation study.
Dr. Jeffrey M. Jacobson from Mt. Sinai Medical Center in New York and colleagues studied 42 HIV-infected patients who had confirmed or presumed acute toxoplasmic encephalitis, according to their report in the March issue of AIDS.
The researchers assigned the patients to one of three treatment groups. Along with pyrimethamine as induction therapy, patients in group 1 received 900 mg/day azithromycin, patients in group 2 received 1200 mg/day azithromycin and those in group 3 received 1500 mg/day azithromycin. The induction period lasted for 6 weeks and was followed by 24 weeks of maintenance therapy, Dr. Jacobson's group reports.
Among the 30 patients available for evaluation, 67% responded to pyrimethamine and azithromycin therapy during the 6-week induction period. With 600 mg of azithromycin alone, the relapse rate during maintenance was 75%; when pyrimethamine 50 mg/day was used in both the induction and maintenance period the relapse rate dropped to under 50%, the investigators found.
For the 15 patients who responded to induction therapy and continued on maintenance therapy, 47% relapsed during the 24-week maintenance period. "Six patients successfully completed induction and maintenance therapy," Dr. Jacobson and colleagues report.
Among patients in group 1, 36% experienced hearing loss or grade III or IV adverse events, and in group 2 over half the patients experienced serious adverse events. However, only two patients in these groups withdrew from therapy due to adverse events.
In group 3, two of the seven patients withdrew because of significant nausea and vomiting, and because of the high frequency of adverse events the researchers could not complete enrollment of patients into this cohort.
"Even though the combination of azithromycin and pyrimethamine is not as good as standard treatment for toxoplasmic encephalitis among HIV patients, it is an alternative for patients who are unable to tolerate sulfonamides and clindamycin," Dr. Jacobson told Reuters Health.
AIDS 2001;15:583-589.
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