Volume 80, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


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 ( < 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 ( = 0.06). Consequently, cotrimoxazole could be a first-line drug regimen for curative treatment and prophylaxis of toxoplasmic encephalitis.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Luft BJ, Hafner R, Korzun AH, Leport C, Antoniskis D, Bosler EM, Bourland DD III, Uttamchandani R, Fuhrer J, Jacobson J, 1993. Toxoplasmic encephalitis in patients with the acquired immunodeficiency syndrome. Members of the ACTG 077p/ANRS 009 Study Team. N Engl J Med 329 : 995–1000. [Google Scholar]
  2. Antinori A, Larussa D, Cingolani A, Lorenzini P, Bossolasco S, Finazzi MG, Bongiovanni M, Guaraldi G, Grisetti S, Vigo B, Gigli B, Mariano A, Dalle Nogare ER, De Marco M, Moretti F, Corsi P, Abrescia N, Rellecati P, Castagna A, Mussini C, Ammassari A, Cinque P, d’Arminio Monforte A, 2004. Prevalence, associated factors, and prognostic determinants of AIDS-related toxoplasmic encephalitis in the era of advanced highly active antiretroviral therapy. Clin Infect Dis 39 : 1681–1691. [Google Scholar]
  3. Dannemann B, McCutchan JA, Israelski D, Antoniskis D, Leport C, Luft B, Nussbaum J, Clumeck N, Morlat P, Chiu J, 1992. Treatment of toxoplasmic encephalitis in patients with AIDS. A randomized trial comparing pyrimethamine plus clindamycin topyrimethamine plus sulfadiazine. The California Collaborative Treatment Group. Ann Intern Med 116 : 33–43. [Google Scholar]
  4. Leport C, Raffi F, Matheron S, Katlama C, Regnier B, Saimot AG, Marche C, Vedrenne C, Vilde JL, 1988. Treatment of central nervous system toxoplasmosis with pyrimethamine/sulfadiazine combination in 35 patients with the acquired immunodeficiency syndrome. Efficacy of long-term continuous therapy. Am J Med 84 : 94–100. [Google Scholar]
  5. Torre D, Speranza F, Martegani R, Zeroli C, Banfi M, Airoldi M, 1998. A retrospective study of treatment of cerebral toxoplasmosis in AIDS patients with trimethoprim-sulphamethoxazole. J Infect 37 : 15–18. [Google Scholar]
  6. Katlama C, De Wit S, O’Doherty E, Van Glabeke M, Clumeck N, 1996. Pyrimethamine-clindamycin vs. pyrimethamine-sulfadiazine as acute and long-term therapy for toxoplasmic encephalitis in patients with AIDS. Clin Infect Dis 22 : 268–275. [Google Scholar]
  7. Torre D, Casari S, Speranza F, Donisi A, Gregis G, Poggio A, Ranieri S, Orani A, Angarano G, Chiodo F, Fiori G, Carosi G, 1998. Randomized trial of trimethoprim-sulfamethoxazole versus pyrimethamine-sulfadiazine for therapy of toxoplasmic encephalitis in patients with AIDS. Italian Collaborative Study Group. Antimicrob Agents Chemother 42 : 1346–1349. [Google Scholar]
  8. Dedicoat M, Livesley N, 2006. Management of toxoplasmic encephalitis in HIV-infected adults (with an emphasis on resource-poor settings). Cochrane Database Syst Rev 3 : CD005420. [Google Scholar]
  9. Canessa A, Del Bono V, De Leo P, Piersantelli N, Terragna A, 1992. Cotrimoxazole therapy of Toxoplasma gondii encephalitis in AIDS patients. Eur J Clin Microbiol Infect Dis 11 : 125–130. [Google Scholar]
  10. Solbreux P, Sonnet J, Zech F, 1990. A retrospective study about the use of cotrimoxazole as diagnostic support and treatment of suspected cerebral toxoplasmosis in AIDS. Acta Clin Belg 45 : 85–96. [Google Scholar]
  11. Francis P, Patel VB, Bill PL, Bhigjee AI, 2004. Oral trimethoprim-sulfamethoxazole in the treatment of cerebral toxoplasmosis in AIDS patients–a prospective study. S Afr Med J 94 : 51–53. [Google Scholar]
  12. Chin TW, Vandenbroucke A, Fong IW, 1995. Pharmacokinetics of trimethoprim-sulfamethoxazole in critically ill and non-critically ill AIDS patients. Antimicrob Agents Chemother 39 : 28–33. [Google Scholar]
  13. Winstanley P, Khoo S, Szwandt S, Edwards G, Wilkins E, Tija J, Coker R, McKane W, Beeching N, Watkin S, 1995. Marked variation in pyrimethamine disposition in AIDS patients treated for cerebral toxoplasmosis. J Antimicrob Chemother 36 : 435–439. [Google Scholar]
  14. Arens J, Barnes K, Crowley N, Maartens G, 2007. Treating AIDS-associated cerebral toxoplasmosis: pyrimethamine plus sulfadiazine compared with cotrimoxazole, and outcome with adjunctive glucocorticoids. S Afr Med J 97 : 956–958. [Google Scholar]
  15. Duval X, Pajot O, Le Moing V, Longuet P, Ecobichon JL, Mentre F, Leport C, Vilde JL, 2004. Maintenance therapy with cotrimoxazole for toxoplasmic encephalitis in the era of highly active antiretroviral therapy. AIDS 18 : 1342–1344. [Google Scholar]
  16. Abgrall S, Rabaud C, Costagliola D, 2001. Incidence and risk factors for toxoplasmic encephalitis in human immunodeficiency virus-infected patients before and during the highly active anti-retroviral therapy era. Clin Infect Dis 33 : 1747–1755. [Google Scholar]
  17. Anglaret X, Chene G, Attia A, Toure S, Lafont S, Combe P, Manlan K, N’Dri-Yoman T, Salamon R, 1999. Early chemoprophylaxis with trimethoprim-sulphamethoxazole for HIV-1-infected adults in Abidjan, Côte d’Ivoire: a randomised trial. Cotrimo-CI Study Group. Lancet 353 : 1463–1468. [Google Scholar]
  18. Wiktor SZ, Sassan-Morokro M, Grant AD, Abouya L, Karon JM, Maurice C, Djomand G, Ackah A, Domoua K, Kadio A, Yapi A, Combe P, Tossou O, Roels TH, Lackritz EM, Coulibaly D, De Cock KM, Coulibaly IM, Greenberg AE, 1999. Efficacy of trimethoprim-sulphamethoxazole prophylaxis to decrease morbidity and mortality in HIV-1-infected patients with tuberculosis in Abidjan, Côte d’Ivoire: a randomised controlled trial. Lancet 353 : 1469–1475. [Google Scholar]

Data & Media loading...

  • Received : 03 Apr 2008
  • Accepted : 29 Dec 2008

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error