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INFECTION FIGHTERS: Toxo--treatment with clarithromycin and minocycline




 

TreatmentUpdate59; Vol 7, No. 5 - May 1995

* STUDY DETAILS Doctors in this study used 6 men and 2 women, all HIV-infected, having an average CD4+ cell count of 18 cells. All had toxo and treatment with pyrimethamine, sulphadiazine and clindamycin caused serious side effects. X-ray scans of their brains detected lesions suggestive of toxo in 7 subjects. In one subject the infection was in the lung.

Six subjects received clarithromycin in doses ranging from 3/4 to 2 g/day and 200 mg/day of minocycline. Subjects received the combination for an average of 9 weeks. During this period of time they also received 75 mg/day of pyrimethamine. The researchers reported results from 6 subjects.

* RESULTS-SYMPTOMS Symptoms cleared in 4 subjects, 3 of whom had 'minimal' brain infection according to the X-ray scans. The 4th subject also lost symptoms and his X-ray scan revealed no lesions in the brain. The researchers note that the recovery seen in these 4 subjects may have been helped by their previous use of standard anti-toxo therapy. Two of the remaining 6 subjects died while receiving anti-toxo treatment. The cause of death was a bacterial infection in one subject and HIV-damage to the brain of the other subject.

* RESULT-MAINTENANCE THERAPY Surviving subjects received clarithromycin 1 to 1.5 g/ day and between 100 and 200 mg/day of minocycline. Three subjects also received 1 tablet of Bactrim/Septra (single strength). Researchers monitored subjects for an average of 7 months. Five subjects did not have further symptoms of toxo. The sixth subject who was also supposed to be taking Bactrim/Septra had another bout of toxo and the researchers suggest that he was not taking that drug. One subject died from complications caused by a stroke about 7 months after he recovered from toxo. Researchers reported no side effects from the combination of clarithromycin and minocycline combination. The study doctors stated that clarithromycin-minocycline may be an option for subjects who have toxo and do not benefit from standard therapy. As well, combination therapy seems to suppress the infection once subjects recover. The researchers suggest that more studies are needed to test regimens such as theirs for patients with toxo.

Other researchers in California are conducting experiments and trying to understand why the immune system fails to keep the parasite that causes toxo under control. Doctors in the USA have recently reported their experience with minocycline. These doctors gave their patient intravenous doxycycline (minocycline) 200 mg/day in addition to intravenous clindamycin 900 mg 3 times daily and oral pyrimethamine 50 mg/day. This combination allowed their patient to recover from toxo.

REFERENCES: 1. La Casein F, Scapha D, Perron C, et al. Clarithromycin-minocycline combination as salvage therapy for toxoplasmosis in patients infected with Human Immunodeficiency Virus. Antimicrobial Agents and Chemotherapy 1995;39(1):276-277.

2. van de Ven ES, Vree T, Milkers W, et al. In vitro effects of sulfadiazine and its metabolites alone and in combination with pyrimethamine on Toxoplasma gondii. Antimicrobial Agents and Chemotherapy 1995;39(3):763-765.

3. Indorf AS and Pogrom P. Use of doxycycline in the management of a patient with Toxoplasmic encephalitis. AIDS 1995;8(1):1633-1634.



 


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Information in this article was accurate in May 1, 1995. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.