Adverse cutaneous reactions to pyrimethamine/sulfadiazine and pyrimethamine/clindamycin in patients with AIDS and toxoplasmic encephalitis. NLM AIDSLINE Important note: Information in this article was accurate in 1996. The state of the art may have changed since the publication date.

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Adverse cutaneous reactions to pyrimethamine/sulfadiazine and pyrimethamine/clindamycin in patients with AIDS and toxoplasmic encephalitis.

Clin Infect Dis. 1995 Sep;21(3):656-8. Unique Identifier : AIDSLINE MED/96077391
Caumes E; Bocquet H; Guermonprez G; Rogeaux O; Bricaire F; Katlama C; Gentilini M; Departement des Maladies Infectieuses, Parasitaires, Tropicales,; et Sante Publique, Hopital Pitie-Salpetriere, Paris, France.

Abstract: We assessed the value of clinical and laboratory parameters for predicting the occurrence of skin reactions induced by pyrimethamine/sulfadiazine and pyrimethamine/clindamycin and the effects of continued therapy for patients with these reactions. We retrospectively studied all episodes of toxoplasmic encephalitis in patients with AIDS who were treated with pyrimethamine/sulfadiazine or pyrimethamine/clindamycin. Eighteen (75%) of 24 patients treated with pyrimethamine/sulfadiazine had cutaneous reactions after a mean of 11 days, whereas 15 (58%) of 26 patients treated with pyrimethamine/clindamycin had cutaneous reactions after a mean of 13 days (P = .56). Nine (50%) of the 18 patients continued to be treated with pyrimethamine/sulfadiazine throughout the duration of hypersensitivity, compared with all 15 patients who were treated with pyrimethamine/clindamycin (P = .002). Nine patients had to stop therapy with pyrimethamine/sulfadiazine (two had Stevens-Johnson syndrome and one had Lyell's syndrome). Thus, treatment throughout the duration of hypersensitivity is more likely to succeed for patients receiving pyrimethamine/clindamycin, whereas therapy with pyrimethamine/sulfadiazine is associated with a high risk of Lyell's syndrome and Stevens-Johnson syndrome.
Keywords: Adult Anti-Infective Agents/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS Antibiotics/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS AIDS-Related Opportunistic Infections/*DRUG THERAPY Clindamycin/ADMINISTRATION & DOSAGE/*ADVERSE EFFECTS Comparative Study Drug Eruptions/*ETIOLOGY Drug Therapy, Combination Encephalitis/*COMPLICATIONS/*DRUG THERAPY Epidermal Necrolysis, Toxic/ETIOLOGY Female Human Male Middle Age Pyrimethamine/ADMINISTRATION & DOSAGE/*ADVERSE EFFECTS Retrospective Studies Risk Factors Stevens-Johnson Syndrome/ETIOLOGY Sulfadiazine/ADMINISTRATION & DOSAGE/*ADVERSE EFFECTS Toxoplasmosis, Cerebral/*COMPLICATIONS/*DRUG THERAPY JOURNAL ARTICLEKWDadultanti-infectiveagents/administration&dosage/adverseeffectsantibiotics/administration&dosage/adverseeffectsaids-relatedopportunisticinfections/KWDdrugtherapyclindamycin/administration&dosage/KWDadverseeffectscomparativestudydrugeruptions/KWDetiologydrugtherapy,combinationencephalitis/KWDcomplications/KWDdrugtherapyepidermalnecrolysis,toxic/etiologyfemalehumanmalemiddleagepyrimethamine/administration&dosage/KWDadverseeffectsretrospectivestudiesriskfactorsstevens-johnsonsyndrome/etiologysulfadiazine/administration&dosage/KWDadverseeffectstoxoplasmosis,cerebral/KWDcomplications/KWDdrugtherapyjournalarticle
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