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Am. J. Trop. Med. Hyg., 80(4), 2009, pp. 583-587
Copyright © 2009 by The American Society of Tropical Medicine and Hygiene

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Cotrimoxazole for Treatment of Cerebral Toxoplasmosis: An Observational Cohort Study during 1994–2006

Guillaume Béraud, Sandrine Pierre-François, Adeline Foltzer, Sylvie Abel, Bernard Liautaud, Didier Smadja, AND André Cabié*
Infectious Diseases Department Comité de Coordination de la Lutte Contre le Virus de l’Immunodéficience Humaine de la Martinique, Neurology Department, Centre d’Investigation Clinique-Epidémiologique Clinique Antilles Guyane (INSERM CIC-EC 802), University Hospital of Fort-de-France, Fort de France, Martinique, France

Cotrimoxazole (trimethoprim/sulfamethoxazole [TMP-SMX]) is an alternative treatment for toxoplasmic encephalitis because it is inexpensive, well-tolerated, and as effective as pyrimethamine-sulfadiazine, which is the first-line drug regimen). We report results of a large cohort study of patients with acquired immunodeficiency syndrome who were treated for toxoplasmic encephalitis with cotrimoxazole. The mean follow-up period was more than three years. Our results confirm that cotrimoxazole is effective (85.5%), with a relatively low incidence of side effects (22%; 7.4% requiring treatment interruption). Relapse occurred in 30.1% of the patients at a mean ± SD of 7.8 ± 16.2 months after the first episode. The only risk factor for relapse was poor treatment and/or prophylaxis adherence. Mortality was significantly higher (P < 0.05) before 1996 than after 1996 (the era of highly active antiretroviral therapy). There was a non-significant trend towards a higher rate of relapse among patients treated before 1996 (P = 0.06). Consequently, cotrimoxazole could be a first-line drug regimen for curative treatment and prophylaxis of toxoplasmic encephalitis.

Received April 3, 2008. Accepted for publication December 29, 2008.

Acknowledgment: We thank David D. Young for substantive help in editing the manuscript.

* Address correspondence to André Cabié, Infectious Disease Department, University Hospital of Fort de France La Meynard, BP 632 97261, Fort de France, Martinique, France. E-mail: andre.cabie{at}chu-fortdefrance.fr

Authors’ addresses: Guillaume Béraud, Sandrine Pierre-François, Adeline Foltzer, Sylvie Abel, Bernard Liautaud, and André Cabié, Infectious Diseases Department, University Hospital of Fort de France, BP 632 97261, Fort de France cedex, Martinique, France, E-mail: andre.cabie{at}chu-fortdefrance.fr. Didier Smadja, Neurology Department, University Hospital of Fort de France, BP 632 97261 Fort de France cedex, Martinique, France.






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Copyright © 2009 by the American Society of Tropical Medicine and Hygiene.