Assuntos
Sulfadiazina , Toxoplasmose Cerebral , Humanos , Sulfadiazina/efeitos adversos , Sulfadiazina/uso terapêutico , Toxoplasmose Cerebral/complicações , Masculino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , HIV-1 , Cristalização , Insuficiência Renal/induzido quimicamente , Adulto , CristalúriaRESUMO
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 (n = 77) versus pyrimethamine/sulfadiazine (n = 35) were compared in 112 pregnant women. RESULTS: Up to 36.6% of women reported adverse reactions to the treatment overall (n = 41). Out of those 38.9% (n = 30) were treated with spiramycin and 31.4% (n = 11) with pyrimethamine/sulfadiazine. Toxic allergic reactions were the only indication for discontinuation of treatment in 8.9% of patients (n = 10), where 9.1% (n = 7) were reported in spiramycin and 8.6% (n = 3) in pyrimethamine/sulfadiazine cohort. Neurotoxic complications (acral paraesthesia) were significantly more frequent during the therapy with spiramycine in 19.5% (n = 15) compared to no cases in pyrimethamine/sulfadiazine group (p = .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 (p = .53 and p = 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.
Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Hipersensibilidade , Espiramicina , Toxoplasmose Congênita , Toxoplasmose , Feminino , Humanos , Gravidez , Espiramicina/efeitos adversos , Pirimetamina/efeitos adversos , Sulfadiazina/efeitos adversos , Toxoplasmose/tratamento farmacológico , Quimioterapia Combinada , Feto , Hipersensibilidade/tratamento farmacológico , Toxoplasmose Congênita/tratamento farmacológicoRESUMO
PURPOSE: The simultaneous occurrence of cerebral toxoplasmosis and cryptococcosis is rare. The infections continue to be treated with sulfadiazine and amphotericin-B-based regimens (preferred therapy), respectively. Both these drugs are linked to some serious adverse drug reactions (ADRs). We report such a unique instance of both; the CNS co-infections and adverse drug reactions to the preferred therapy. CASE PRESENTATION: A 44-year-old Asian-Indian female was diagnosed with cerebral toxoplasmosis, impending cryptococcal meningoencephalitis, and acquired immune deficiency syndrome (AIDS). The preferred therapy of opportunistic CNS co-infections commenced. Within a week, she had an occurrence of fall in hemoglobin concentrations (11.3 g/dL to 5.6 g/dL; grade IV), reticulocytosis (1% to 3.2%), and indirect hyperbilirubinemia (0.5 mg/dL to 2.8 mg/dL; grade IV) after sulfadiazine administration. The drug was discontinued and the patient was treated with hematocrit transfusions. After amphotericin-B deoxycholate (AmBd) administration, the patient developed hypokalemia (serum potassium; 4.5 mmol/L to 2.7 mmol/L) and increased serum creatinine (1.0 to 2.2 mg/dL; stage-I) levels. Hence, AmBd was discontinued and potassium correction was given. The patient got diagnosed with sulfadiazine induced hemolytic anemia and AmBd induced acute renal failure. He was switched to alternative therapy regimens for the treatment of cerebral toxoplasmosis and cryptococcosis. Radiological investigations were followed up to confirm the clinical outcomes of alternative therapy. Complete recovery from the ADRs and opportunistic infections was observed. CONCLUSION: The preferred therapy regimens for toxoplasmosis and cryptococcosis are accompanied by potential adverse drug reactions, thus continuous monitoring is vital, especially in the initial phases of therapy. Discontinuation of the treatment should be the preliminary intervention in the management. Having said that, alternative therapy regimens had an optimal clinical response in the present case.
Assuntos
Síndrome da Imunodeficiência Adquirida , Coinfecção , Criptococose , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Toxoplasmose Cerebral , Masculino , Humanos , Feminino , Adulto , Anfotericina B/efeitos adversos , Síndrome da Imunodeficiência Adquirida/induzido quimicamente , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Antifúngicos/efeitos adversos , Toxoplasmose Cerebral/diagnóstico , Toxoplasmose Cerebral/tratamento farmacológico , Toxoplasmose Cerebral/induzido quimicamente , Coinfecção/induzido quimicamente , Coinfecção/complicações , Coinfecção/tratamento farmacológico , Criptococose/complicações , Criptococose/diagnóstico , Criptococose/tratamento farmacológico , Sulfadiazina/efeitos adversos , Potássio/uso terapêuticoRESUMO
Changes in immune response of children with congenital toxoplasmosis (CT) regarding infection evolution and therapeutic intervention was addressed. Infants with CT presented increased counts of monocytes, CD3-CD16-CD56High, CD3+CD56+ and CD4+ T-cells 1-year after treatment onset (TOXO1-yearAT). Smaller numbers of CD3-CD16-CD56+ and TCRγδ+ T-cells were specifically observed in infants with retinochoroidal lesions (L(+)). When infants were classified based on the baseline status, expansion of CD3-CD16-CD56High and CD4+ T-cells were observed in L(+) who had active, active/cicatricial or cicatricial lesions. Infants who had active or active/cicatricial lesions display augmented numbers of monocytes, CD3-CD16+CD56+, CD3+CD56+, CD8+DR+ and TCRγδ+ T-cells and those with active/cicatricial or cicatricial at baseline displayed increase in CD14+CD64+ monocytes. Moreover, all L(+) had increased IFN-γ+ and IL-10+ CD4+ T-cells, while L(-) had increased ratios of TNF+, IFN-γ+ and IL-4+ NK-cells upon antigen-specific stimulation. Persistent alterations in leukocytes in TOXO1-yearAT suggest long-term sequels in the immune system of infants with CT.
Assuntos
Antiprotozoários/efeitos adversos , Linfócitos/efeitos dos fármacos , Monócitos/efeitos dos fármacos , Toxoplasmose Congênita/tratamento farmacológico , Toxoplasmose Congênita/imunologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Fenótipo , Pirimetamina/efeitos adversos , Sulfadiazina/efeitos adversos , TempoRESUMO
Combination therapy for toxoplasmosis consists of sulfadiazine, pyrimethamine and leucovorin. Although sulfadiazine can cause hypersensitivity reactions, such as fever, rash and liver dysfunction, there is no consensus on an effective therapy for congenital toxoplasmosis (CTox) without sulfadiazine. We attempted desensitization to sulfadiazine in 2 patients with CTox and sulfadiazine hypersensitivity. Desensitization was achieved for 1 patient.
Assuntos
Antiprotozoários/efeitos adversos , Dessensibilização Imunológica/estatística & dados numéricos , Hipersensibilidade a Drogas/diagnóstico , Sulfadiazina/efeitos adversos , Toxoplasmose Congênita/tratamento farmacológico , Pré-Escolar , Dessensibilização Imunológica/métodos , Humanos , Recém-Nascido , Masculino , Toxoplasmose Congênita/diagnósticoRESUMO
For many years, the University of Chicago administered sulfamethoxazole-trimethoprim sulfate (SMZ-TMP) oral suspension to select immunocompromised mouse colonies via the drinking water. In 2014, SMZ-TMP oral suspension was placed on back-order and medicated diet with a different sulfonamide, sulfadiazine-trimethoprim (SDZ-TMP) was used as a replacement. Months after this transition, sentinel mice from the same room as one of the remaining immunocompromised colonies on this diet were found dead or appeared sick. Necropsies revealed cardiomegaly, and histology confirmed myocardial fibrosis in the first 4 sentinel mice examined, consistent with cardiomyopathy. Subsequent sequential monitoring of 2 sentinel mice via echocardiography showed their progression toward decreased cardiac function. Investigation of the housing room revealed that the sentinel mice had been accidently placed on SDZ-TMP diet upon entering the colony housing room. This case report describes cardiomyopathy in 6 ICR mice after long term consumption of SDZ-TMP medicated feed.
Assuntos
Antibacterianos/efeitos adversos , Cardiomiopatias/induzido quimicamente , Sulfadiazina/efeitos adversos , Trimetoprima/efeitos adversos , Administração Oral , Animais , Antibacterianos/administração & dosagem , Cardiomiopatias/patologia , Combinação de Medicamentos , Feminino , Imunocompetência , Camundongos , Camundongos Endogâmicos ICR , Sulfadiazina/administração & dosagem , Trimetoprima/administração & dosagemAssuntos
Encéfalo/diagnóstico por imagem , Cálculos Renais/induzido quimicamente , Transplante de Fígado/efeitos adversos , Sulfadiazina/efeitos adversos , Toxoplasmose Cerebral/sangue , Assistência ao Convalescente , Antimaláricos/uso terapêutico , Antiprotozoários/efeitos adversos , Antiprotozoários/uso terapêutico , Atovaquona/administração & dosagem , Atovaquona/uso terapêutico , Encéfalo/parasitologia , Edema Encefálico/diagnóstico por imagem , Feminino , Humanos , Cálculos Renais/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Pentamidina/efeitos adversos , Pentamidina/uso terapêutico , Pneumonia por Pneumocystis/prevenção & controle , Sulfadiazina/uso terapêutico , Toxoplasmose Cerebral/líquido cefalorraquidiano , Toxoplasmose Cerebral/tratamento farmacológico , Toxoplasmose Cerebral/parasitologia , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Ultrassonografia/métodosRESUMO
Antiseptics are chemical substances that when applied topically onto intact skin, mucous membranes or wounds partially or completely reduces the population of living microorganisms in those tissues. Different types of antiseptics are available - those most commonly used in clinical practice being alcohols, iodinated compounds and chlorhexidine. When using an antiseptic, consideration is required of its spectrum of antimicrobial activity, latency, residual effects, possible interferences of the presence of organic material with the activity of the antiseptic, its side effects, compatibility with other antiseptics, and cost. This article is part of a supplement entitled "Antisepsis in the critical patient", which is sponsored by Becton Dickinson.
Assuntos
Álcoois/farmacologia , Anti-Infecciosos Locais/farmacologia , Compostos de Iodo/farmacologia , Álcoois/efeitos adversos , Anti-Infecciosos Locais/efeitos adversos , Anti-Infecciosos Locais/classificação , Cátions/efeitos adversos , Cátions/farmacologia , Clorexidina/efeitos adversos , Clorexidina/farmacologia , Interações Medicamentosas , Etanol/efeitos adversos , Etanol/farmacologia , Humanos , Peróxido de Hidrogênio/efeitos adversos , Peróxido de Hidrogênio/uso terapêutico , Unidades de Terapia Intensiva , Iodo/efeitos adversos , Iodo/farmacologia , Compostos de Iodo/efeitos adversos , Iodóforos/efeitos adversos , Iodóforos/farmacologia , Compostos de Mercúrio/farmacologia , Propranolol/efeitos adversos , Propranolol/farmacologia , Sulfadiazina/efeitos adversos , Sulfadiazina/farmacologia , Triclosan/efeitos adversos , Triclosan/farmacologiaAssuntos
Clindamicina/administração & dosagem , Dexametasona/administração & dosagem , Síndrome de Hipersensibilidade a Medicamentos/tratamento farmacológico , Injeções Intravítreas , Toxoplasmose Ocular/tratamento farmacológico , Idoso , Síndrome de Hipersensibilidade a Medicamentos/complicações , Substituição de Medicamentos , Feminino , Humanos , Pirimetamina/efeitos adversos , Sulfadiazina/efeitos adversos , Toxoplasma/fisiologia , Toxoplasmose/complicações , Toxoplasmose/diagnóstico , Toxoplasmose/tratamento farmacológico , Toxoplasmose Ocular/complicações , Toxoplasmose Ocular/diagnósticoRESUMO
Background: The purpose of this study was to estimate the frequency and describe the adverse drug reactions (ADRs) associated with the classic treatment of ocular toxoplasmosis (OT), namely sulfadiazine, pyrimethamine, corticosteroids and folinic acid. Methods: We performed a descriptive study of a prospective cohort of patients with OT treated with the classic therapy. Data were collected during medical consultations and treatment. Results: Of the 147 patients studied, 85% developed one or more ADR. Women presented more ADRs than men (95% vs 77%). Of the total reactions (n=394), 82% were mild, but we found one life-threatening event (Stevens-Johnson syndrome). The most frequent types (71%) of ADRs were gastrointestinal, skin and neurological or psychiatric. The majority of ADRs (90.3%) occurred before the second week of treatment. A third of the patients were treated for the ADR and 10% dropped out of OT treatment. Most (70%) of the ADRs were characterized as being probably caused by the drugs and may be associated with prednisone, sulfadiazine and sulfadiazine/prednisone. Six percent of ADRs were not previously described, such as taste alteration, constipation/bloating, dyspnoea, sweating and somnolence. Conclusions: Our results suggest a high rate of ADRs to OT classic treatment, which requires careful follow-up in order to identify and treat ADRs early.
Assuntos
Antídotos/efeitos adversos , Antiprotozoários/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Toxoplasmose Ocular/tratamento farmacológico , Adolescente , Corticosteroides/efeitos adversos , Corticosteroides/uso terapêutico , Adulto , Sistemas de Notificação de Reações Adversas a Medicamentos , Idoso , Antídotos/uso terapêutico , Antiprotozoários/uso terapêutico , Brasil/epidemiologia , Comorbidade , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/terapia , Feminino , Humanos , Leucovorina/efeitos adversos , Leucovorina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Pirimetamina/efeitos adversos , Pirimetamina/uso terapêutico , Sulfadiazina/efeitos adversos , Sulfadiazina/uso terapêutico , Toxoplasmose Ocular/epidemiologia , Resultado do Tratamento , Adulto JovemAssuntos
Síndrome de Hipersensibilidade a Medicamentos/etiologia , Síndrome de Hipersensibilidade a Medicamentos/imunologia , Exantema/induzido quimicamente , Exantema/imunologia , Ativação Linfocitária/imunologia , Sulfadiazina/imunologia , Sulfametoxazol/imunologia , Feminino , Humanos , Ativação Linfocitária/efeitos dos fármacos , Pessoa de Meia-Idade , Sulfadiazina/efeitos adversos , Sulfametoxazol/efeitos adversosRESUMO
There are no standard guidelines for the treatment of cryptosporidiosis in reptiles. The aim of this study was to evaluate the efficacy of two cryptosporidiosis therapies in captive green iguanas. Eight green iguanas aged 2-6 years, including 6 (1 â and 5 â) animals with chronic diarrhea, received treatment for cryptosporidiosis. The presence of Cryptosporidium sp. oocysts was determined in 8 iguanas (100%), Isospora sp. oocysts were detected in 3 animals (37.5%), and Oxyuridae eggs were observed in 5 iguanas (62.5%). The animals were divided into two therapeutic groups (A and B). Group A iguanas were administered halofuginone (Halocur, 0,50â¯mg/ml Intervet Productions S.A., France) at a dose of 110â¯mg/kg body weight (BW) every 7â¯days for 5 weeks. Group B animals were administered sulfadiazine and trimethoprim (Norodine Vet Oral Paste sulfadiazine 288,3â¯mg/g, trimethoprim 58â¯mg/g, ScanVet Animal Health A/S, Denmark) at 75â¯mg/kg BW per os every 5â¯days for 5 weeks and spiramycin and metronidazole (Stomorgyl, spiramycin 1500000 IU, metronidazole 250â¯mg, Merial, France) at 200â¯mg/kg BW every 5â¯days for 5 weeks. Both groups received hyperimmune bovine colostrum and subcutaneous fluids. Before treatment, the average number of Cryptosporidium sp. oocysts in 1â¯g of feces was determined at 1.71â¯*â¯105 (±313,262.44) in group A and 1.56â¯*â¯105 (±262,908.53) in group B; the average number of Isospora sp. oocysts was determined at 3.53â¯*â¯103 (±1747.38), and the average number of Oxyuridae eggs was determined at 810 (±496.74). Blood tests were performed once before treatment. The results of blood morphology and biochemistry tests before treatment revealed leukocytosis with a significant increase in heterophile and monocyte counts in all animals. Dehydration, elevated hematocrit values and low levels of Na+, Ca2+, PO4- and Cl- ions were observed in 6 iguanas. Two iguanas died during treatment. The gross necropsy revealed acute inflammation of gastric and duodenal mucosa, mucosal ecchymoses in the gastrointestinal tract, hepatomegaly and liver congestion, cholecystitis, enlarged kidneys and renal edema and congestion, cystitis, and an absence of fat bodies. Parasites were not detected in any developmental form after 40â¯days of therapy and during an monthly 18-month follow-up period. Effective treatment of cryptosporidiosis in reptiles minimizes the adverse consequences of disease, improves the animals' well-being and decreases euthanasia rates.
Assuntos
Coccidiostáticos/administração & dosagem , Coccidiostáticos/uso terapêutico , Criptosporidiose/tratamento farmacológico , Cryptosporidium/efeitos dos fármacos , Iguanas/parasitologia , Animais , Coccidiostáticos/efeitos adversos , Criptosporidiose/sangue , Criptosporidiose/epidemiologia , Criptosporidiose/parasitologia , Cryptosporidium/isolamento & purificação , Fezes/parasitologia , Mucosa Intestinal/efeitos dos fármacos , Mucosa Intestinal/parasitologia , Oocistos/efeitos dos fármacos , Piperidinas/administração & dosagem , Piperidinas/efeitos adversos , Piperidinas/uso terapêutico , Polônia/epidemiologia , Quinazolinonas/administração & dosagem , Quinazolinonas/efeitos adversos , Quinazolinonas/uso terapêutico , Sulfadiazina/administração & dosagem , Sulfadiazina/efeitos adversos , Sulfadiazina/uso terapêutico , Resultado do Tratamento , Trimetoprima/administração & dosagem , Trimetoprima/efeitos adversos , Trimetoprima/uso terapêuticoAssuntos
Complicações na Gravidez/tratamento farmacológico , Pirimetamina/uso terapêutico , Síndrome de Stevens-Johnson/tratamento farmacológico , Sulfadiazina/uso terapêutico , Toxoplasmose/tratamento farmacológico , Adulto , Cesárea , Feminino , Seguimentos , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Complicações na Gravidez/diagnóstico , Diagnóstico Pré-Natal/métodos , Pirimetamina/efeitos adversos , Doenças Raras , Medição de Risco , Síndrome de Stevens-Johnson/etiologia , Síndrome de Stevens-Johnson/fisiopatologia , Sulfadiazina/efeitos adversos , Toxoplasmose/diagnóstico , Resultado do TratamentoRESUMO
BACKGROUND: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe disease that may be complicated by hemophagocytic lymphohistiocytosis but this is rarely described in children. PATIENTS AND METHODS: We report the case of a 5-week old infant hospitalized in a pediatric intensive care unit for hemophagocytic lymphohistiocytosis with prolonged fever, splenomegaly, cytopenia, fibrinogen≤1.5g/L, ferritin≥500µg/L, and soluble IL-2 receptor≥2400U/mL. As a result of the presence of a diffuse skin rash, eosinophilia and multiple organ failure that started three weeks after the initiation of a congenital toxoplasmosis treatment, association with DRESS was suggested. DISCUSSION: Exposure to sulfadiazine remains the main factor leading to DRESS in this case. This is probably the trigger event, secondarily complicated by hemophagocytic lymphohistiocytosis, although in our case the diagnosis was made subsequently. The unfortunately poor outcome of this association is probably exacerbated in fragile patients such as young infants. CONCLUSION: Clinicians should be aware of the possibility of DRESS of every early onset associated with hemophagocytic lymphohistiocytosis linked to a treatment started during the neonatal period to avoid any delay in care that might adversely affect the prognosis.
Assuntos
Antiprotozoários/efeitos adversos , Síndrome de Hipersensibilidade a Medicamentos/complicações , Linfo-Histiocitose Hemofagocítica/complicações , Pirimetamina/efeitos adversos , Sulfadiazina/efeitos adversos , Toxoplasmose Congênita/complicações , Antiprotozoários/administração & dosagem , Síndrome de Hipersensibilidade a Medicamentos/etiologia , Quimioterapia Combinada , Evolução Fatal , Cardiopatias/complicações , Cardiopatias/congênito , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica , Miocardite/etiologia , Pirimetamina/administração & dosagem , Fatores de Risco , Sulfadiazina/administração & dosagem , Toxoplasmose Congênita/tratamento farmacológicoRESUMO
BACKGROUND: There are few studies reporting frequency and control of adverse events associated with congenital toxoplasmosis treatment. The objective of this study is to describe treatment adherence and adverse hematologic events in a cohort of children identified with congenital toxoplasmosis in Minas Gerais, Brazil. METHODS: Children were treated with sulfadiazine, pyrimethamine and folinic acid and were evaluated clinically and by laboratory tests at regular intervals. RESULTS: Of 146,307 live newborns who participated in the Neonatal Screening Program in Minas Gerais in 2006-2007, 190 had congenital toxoplasmosis. Among the 171 children whose treatment data were available, 73.1% completely adhered to antiparasitic therapy. Hematologic adverse events (macrocytic anemia and/or neutropenia and/or thrombocytopenia) were diagnosed in 44% of them. The most common adverse event was neutropenia (31%). In most cases, it was not severe and reversed after increase in folinic acid dosage (25.7%) or temporary treatment suspension (1.8%). No infections were observed in association with neutropenic events. Significant associations were detected between macrocytic anemia and lower weight Z score at first medical appointment (P = 0.03), and between severe neutropenia (<500/mm) and lower weight Z score toward the end of treatment (P = 0.04). CONCLUSIONS: The high frequency of hematologic adverse events found, especially in malnourished children, highlight the importance of careful monitoring of these children throughout treatment, as well as considering nutritional aspects and the need for higher doses of folinic acid. With adequate monitoring, antiparasitic treatment was feasible and relatively safe in the setting of this large screening program for congenital toxoplasmosis.
Assuntos
Antiprotozoários/efeitos adversos , Medula Óssea , Neutropenia/induzido quimicamente , Toxoplasmose Congênita/tratamento farmacológico , Toxoplasmose Congênita/epidemiologia , Antiprotozoários/uso terapêutico , Medula Óssea/efeitos dos fármacos , Medula Óssea/fisiopatologia , Brasil/epidemiologia , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Triagem Neonatal , Neutropenia/diagnóstico , Neutropenia/epidemiologia , Estudos Prospectivos , Pirimetamina/efeitos adversos , Pirimetamina/uso terapêutico , Sulfadiazina/efeitos adversos , Sulfadiazina/uso terapêutico , Toxoplasmose Congênita/complicaçõesRESUMO
OBJECTIVES: The objective of this study was to perform a systematic review and meta-analysis of the literature to evaluate the efficacy and safety of therapies for cerebral toxoplasmosis in HIV-infected adults. The pyrimethamine plus sulfadiazine (P-S) combination is considered the mainstay therapy for cerebral toxoplasmosis and pyrimethamine plus clindamycin (P-C) is the most common alternative treatment. Although trimethoprim-sulfamethoxazole (TMP-SMX) has potential advantages, its use is infrequent. METHODS: We searched PubMed and four other databases to identify randomized controlled trials (RCTs) and cohort studies. Two independent reviewers searched the databases, identified studies and extracted data. Risk ratios (RRs) were pooled across studies using random-effects models. RESULTS: Nine studies were included (five RCTs, three retrospective cohort studies and one prospective cohort study). In comparison to P-S, treatment with P-C or TMP-SMX was associated with similar rates of partial or complete clinical response [P-C: RR 0.87; 95% confidence interval (CI) 0.70-1.08; TMP-SMX: RR 0.97; 95% CI 0.78-1.21], radiological response (P-C: RR 0.92; 95% CI 0.82-1.03), skin rash (P-C: RR 0.81; 95% CI 0.56-1.17; TMP-SMX: RR 0.17; 95% CI 0.02-1.29), gastrointestinal impairment (P-C: RR 5.16; 95% CI 0.66-40.11), and drug discontinuation because of adverse events (P-C: RR 0.32; 95% CI 0.07-1.47). Liver impairment was more frequent with P-S than P-C (P-C vs. P-S: RR 0.48; 95% CI 0.24-0.97). CONCLUSIONS: The current evidence fails to identify a superior regimen in terms of relative efficacy or safety for the treatment of HIV-associated cerebral toxoplasmosis. Use of TMP-SMX as preferred treatment may be consistent with the available evidence and other real-world considerations. Larger comparative studies are needed.
Assuntos
Antiprotozoários/efeitos adversos , Antiprotozoários/uso terapêutico , Infecções por HIV/complicações , Toxoplasmose Cerebral/tratamento farmacológico , Combinação Trimetoprima e Sulfametoxazol/efeitos adversos , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Adulto , Clindamicina/efeitos adversos , Clindamicina/uso terapêutico , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pirimetamina/efeitos adversos , Pirimetamina/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Sulfadiazina/efeitos adversos , Sulfadiazina/uso terapêuticoRESUMO
Polypharmacy, specifically the overuse and misuse of medications, is associated with adverse health events, increased disability, hospitalizations, and mortality. Mechanisms through which polypharmacy may increase adverse health outcomes include decreased adherence, increased drug side effects, higher use of potentially inappropriate medications, and more frequent drug-drug interactions. This article reviews clinical problems associated with polypharmacy and presents a framework to optimize prescribing for older adults.
Assuntos
Idoso de 80 Anos ou mais/fisiologia , Idoso/fisiologia , Polimedicação , Padrões de Prática Médica/normas , Bloqueadores dos Canais de Cálcio/efeitos adversos , Clopidogrel , Combinação de Medicamentos , Interações Medicamentosas , Humanos , Prescrição Inadequada , Rim/fisiologia , Fígado/metabolismo , Erros de Medicação/prevenção & controle , Osteoporose/induzido quimicamente , Osteoporose/prevenção & controle , Cooperação do Paciente , Farmacocinética , Guias de Prática Clínica como Assunto , Inibidores da Bomba de Prótons/efeitos adversos , Quinolonas/efeitos adversos , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Sulfadiazina/efeitos adversos , Ticlopidina/efeitos adversos , Ticlopidina/análogos & derivados , Trimetoprima/efeitos adversosRESUMO
Children treated for toxoplasma retinochoroiditis may experience a range of severe adverse drug responses. Drug reaction with eosinophilia and systemic symptoms syndrome is a life-threatening idiosyncratic drug reaction with a 10% mortality. We present a case of drug reaction with eosinophilia and systemic symptoms syndrome in a child on standard combination treatment with oral sulfadiazine, pyrimethamine, folinic acid, and steroids for toxoplasma retinochoroiditis. Early clinical recognition and appropriate treatment led to a complete recovery and no longterm sequelae. The parents of children during sulfadiazine treatment should be counseled on the potential significance of nonspecific illness.