Page 1 of 3: Ophthalmology : Toxoplasmosis

rsvv79 · Credits: 5424 My Scrapbook

Toxoplasmosis in AIDS can be treated with all EXCEPT

1. Atavaquone
2. Azithromycin
3. Pyrimethamine
4. Clindamycin

The answer given is 3 but most likely it is wrong.Harrisons confirms 3 as one of the recommended drugs.Anyone with the correct answer??What about 4 and 1.??

bhavu · Credits: 9491 My Scrapbook

harrsion mentions pyrimethamine is doc of hiv than sulpha than clinda. i think it should be 1.(though al 4 mentioned in the trteatment but in immunocomressed abouve 3 is only menioned)

nutsnitin · Credits: 15174 My Scrapbook

harry says.........Infection in Immunocompromised Patients Patients with AIDS should be treated for acute toxoplasmosis; in the immunocompromised patient, toxoplasmosis is rapidly fatal if untreated. The mainstay of treatment for Toxoplasma encephalitis in immunocompromised patients is a combination regimen. Administered together for 4 to 6 weeks or until radiologic improvement is documented, pyrimethamine (a 200-mg loading dose followed by 50 to 75 mg/d) and sulfadiazine (4 to 6 g/d in four divided doses) block folic acid metabolism and reduce the parasite burden. Leucovorin (calcium folinate, 10 to 15 mg/d) is given as an adjunct to prevent the bone marrow toxicity associated with pyrimethamine. Both pyrimethamine and sulfadiazine cross the blood-brain barrier. A prominent consequence of dual therapy is the high incidence of associated toxicity (40%). Rash may develop during the first 3 weeks in up to 20% of patients but does not preclude the use of this combination. Other complications include hematologic effects, crystalluria, hematuria, radiolucent renal stones, and nephrotoxicity. During therapy, serum levels of these drugs may be erratic, but such fluctuations have not been correlated with these complications.

Pyrimethamine and sulfadiazine are active only against the tachyzoite stage of the parasite. Thus, after immunocompromised patients complete the initial 4- to 6-week course, they must receive lifelong suppressive therapy with pyrimethamine (25 to 50 mg/d) and sulfadiazine (2 to 4 g/d). If sulfadiazine cannot be tolerated, a combination of pyrimethamine (75 mg/d) plus clindamycin (450 mg tid) can be used. It is possible that pyrimethamine (50 to 75 mg/d) is sufficient for chronic suppressive therapy.

Alternative Regimens Alternative therapies have been established because of the toxicity associated with the long-term antimicrobial therapy necessary for many individuals infected with T. gondii. Dapsone (diaminodiphenyl sulfone), with its longer serum half-life and decreased toxicity, is an effective alternative to sulfadiazine. Spiramycin, which has been used in Europe to treat pregnant women, reduces transplacental transmission. However, spiramycin has been ineffective as primary prophylaxis in patients with AIDS. Clindamycin is well absorbed from the gastrointestinal tract, and serum levels peak 1 to 2 h after administration. The combination of oral pyrimethamine (25 to 75 mg/d) plus intravenous clindamycin (1200 to 4800 mg/d) is effective for patients with AIDS who have Toxoplasma encephalitis. Toxic effects of clindamycin include nausea, vomiting, neutropenia, rash, and pseudomembranous colitis. Other macrolides that have been evaluated include roxithromycin, clarithromycin, and azithromycin. Evidence suggests that the macrolides are not beneficial by themselves, but a combination of pyrimethamine and clarithromycin appears to be effective. Atovaquone (750 mg tid or qid) is an optional agent for the treatment of individuals who are intolerant of other agents. Glucocorticoids can be used to treat intracerebral edema, but their benefit has not yet been established. It is difficult to assess the benefit of glucocorticoids when they are administered in conjunction with anti-Toxoplasma medication. Anticonvulsants are sometimes necessary for the treatment of seizures, but attention should be given to the potential interaction between sulfadiazine and phenytoin.

atovaquone is only used when others ( other trhree fail..)..

draditithegreat · Credits: 1248020 My Scrapbook

so ans is none!

DRATKINS · Credits: 8535 My Scrapbook

watz toxoplasmosis triad ..

DRATKINS · Credits: 8535 My Scrapbook

ANS IS NONE , AS ALL DRUGS R USED.

BRAVO · Credits: 46105 My Scrapbook

manpreet108 · Credits: 30702 My Scrapbook

its the criteria defining congenital toxoplasmosis--
choroidoretinitis.
cerebral calcification.
convulsions.

pls correct me drats if i am wrong here.

draditithegreat · Credits: 1248020 My Scrapbook

we find calcification in CMV?

manpreet108 · Credits: 30702 My Scrapbook

DOC for toxoplasmosis in pregnancy is spiramycin -right??

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