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Utility of tetracycline derivatives in treatment of CNS toxoplasmosis.


Int Conf AIDS. 1993 Jun 6-11;9(1):373 (abstract no. PO-B10-1427). Unique

OBJECTIVE: To describe the efficacy of tetracycline derivative alone or in combination with pyrimethamine (P) in therapy of CNS toxoplasmosis. METHODS: Prospective evaluation of 7 patients with biopsy proven (4) or presumed (3) CNS toxoplasmosis. Responses to therapy is defined as complete alleviation of symptoms as well as shrinkage of the CNS lesion by at least 75%. RESULTS: All patients responded to initial treatment-[doxycycline alone (1) 4 mg/kg/day, minocycline alone (3) 4 mg/kg/day, or (P)/minocycline 1)]. The 2 other patients who had not responded and/or tolerated standard toxoplasma medications had a complete response to either doxycycline alone or (P)/minocycline. Three patients died of unrelated AIDS complications; 2 at autopsy had no evidence of CNS or systemic toxoplasmosis, the other had a negative premorbid MRI of the head. Four patients are alive and asymptomatic on P)/minocycline (2) or minocycline alone (2). The maximum time of prospective follow-up to date is 15 months. CONCLUSIONS: 1.) Tetracycline derivatives, particularly minocycline are efficacious in therapy of CNS toxoplasmosis either alone or in combination with (P). 2.) Efficacy was also seen in patients intolerant or unresponsive to standard therapies. 3.) No significant toxicity was seen. 4.) While controlled studies will be necessary to establish superiority as compared to standard therapies, the safety and efficacy of minocycline compels us to begin a prophylactic study with this agent for prevention of symptomatic toxoplasmosis.

*AIDS-Related Opportunistic Infections/DRUG THERAPY *Central Nervous System Diseases/DRUG THERAPY *Doxycycline/THERAPEUTIC USE *Minocycline/THERAPEUTIC USE *Toxoplasmosis/DRUG THERAPY *Toxoplasmosis, Cerebral/DRUG THERAPY


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