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B. Iaccheri, T. Fiore, T. Papadaki, S. Androudi, C. Foster; Adverse Reactions with Antitoxoplasma Therapy . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1415.
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Purpose: To characterize the incidence and the type of adverse reactions related to the different drugs used for active ocular toxoplasmosis. Methods: We reviewed the clinical records of a consecutive series of patients with active toxoplasma retinochoroiditis examined between March 1991 and August 2002. One of the following five regimens was used: clindamycin plus sulfadiazine plus pyrimethamine, clindamycin plus sulfadiazine, clindamycin plus sulfamethoxazole-trimethoprim, sulfadiazine plus pyrimethamine, atovaquone. All adverse events were recorded and the drug most likely responsible for the adverse reaction was discontinued and replaced. Results: Fifty-five patients were treated. Clindamycin was the most commonly employed drug (50 patients), followed by sulfadiazine (40 patients), pyrimethamine (33 patients), sulfamethoxazole-trimetoprim (16 patients), and atovaquone (10 patients). Twenty-two (40%) patients developed 27 adverse reactions to the therapy. The most commonly encountered complications were rash [(19 cases, (34.5%) mostly caused by sulfadiazine and clindamycin)], and gastrointestinal side effects [diarrhea (6 cases, 10.9%) bleeding (1 case, 1.8%) and stomach upset (6 cases, 10.9%), mostly caused by clindamycin]. The most serious complication was leukopenia in one patient treated with pyrimethamine. One case of facial edema was also recorded. The adverse events were reversible in all cases. Conclusion: The drugs currently used in the treatment of ocular toxoplasmosis carry an overall high incidence of associated side effects. The evaluation of different ways of administration anti-toxoplasma drug might reveal in the future better strategies for ocular anti toxoplasma therapy in terms of efficacy and side effects.
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