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Neurotoxoplasmosis Drug Resistance
Jun 30, 2004

Doctor,

My grandmother is 65 years old and has HIV. She developed neurotoxoplasmosis as an oportunist infection and started the regular treatment with Sulfadiazine, but she developed a resistance to Sulfadizine so it wouldn't be effective anymore. So she started to treat with Clindamycin and it is aparently causing some sort of allergy on her... so i would like to know if there is any other replacement drug for the same purpose that she can start using instead of this two (sulfadiazine and clindamycin), and what could be done.

Thanks and sorry about my english.

Douglas from Brazil

Response from Dr. Sherer

As susceptibilty tests are not routinely done for toxoplasmosis, I will assume that the reason for discontinuing sulfadiazine plus pyrimethamine was a lack of clinical response, rather than resistance. This happens often, i.e. a lack of clinical response occurs in 10-35% of patients in various clinical studies.

Rash and other forms of intolerance are unfortunately common with clindamycin, occuring in 20% of patients in some clinical trials.

Studies on alternative regimens to the above two standard regimens are few, and so I will simply note some of the regimens that have been tried, as options that you can discuss with your grandmother's physician. Success rates have varied in uncontrolled clinical studies with these agents, in the range of 40-60% for initial response. Alternative regimens include TMP-SMX (Bactrim) + pyrimethamine + either dapsone, clarithromycin or azithromycin; trimetrexate + pyimethamine (with leakovorin 'rescue'), and atovaquone monotherapy.


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