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Clarithromycin + minocycline as a treatment for cerebral toxoplasmosis (CT) in HIV-infected patients (PTS).
Rabaud CH; Arniel C; Maignan M; Hoen B; May TH; Canton PH; Department of
November 30, 1996
3rd Conf Retro and Opportun Infect. 1996 Jan 28-Feb 1;:160. Unique

The treatment of CT should not be discontinued in HIV-infected pts. Pyrimethamine in combination with sulfadiazine or clindamycin is the standard therapy, but side-effects of these drugs are reported in 20-30%. of the cases, leading to the discontinuation of the treatment. In such occurence, alternative therapy is required. The efficacy of clarithromycin combined with minocycline was previously reported in mice. We studied the efficiancy of this treatment in HIV-infected pts presenting CT unable to tolerate the conventional treatment. Eight HIV-infected pts (mean CD4+ lymphocyte count = 58/mm 3 ) were treated for CAT scan-confirmed CT with pyrimethamine 100 mg/d combined with either sulfadiazine 6 g/d (7 pts) or clindamycin 3.6 g/d (1 patient). In all cases, severe side effects (hematologic: 7 pts or diarrhea: 1 patient) percluded the continuation of this therapy. Before these side effects were reported, the mean duration of initial treatment was 114 days (15 - 180). At that time, CT was considered to be cured or significantly improved in all pts who were subsequently treated with clarithromycin 2 g/d + minocycline 200 mg/d. Nausea and vomiting occured after few days of clarithromycin treatment at 2 g/d but disappeared after dosage reduction to 1 g/d. In all the but one pts, this treatment was continued until patient's death and is still ongoing in 2 pts. In one patient, neutropenia reoccured after 11 months and treatment was replaced by atovaquone. No other side effect was noted. Mean duration of follow-up was 11.75 months. No relapse was reported. No Mycobacterium avium complex infection occured in these pts. CIarithromycin associated with minocycline appeared to be an effective alternative therapy of CT in HIV-infected pts when used after intolerance to standard treatment.

Anti-Infective Agents/ADMINISTRATION & DOSAGE/*THERAPEUTIC USE Brain Diseases/COMPLICATIONS/*DRUG THERAPY CD4 Lymphocyte Count Clarithromycin/ADMINISTRATION & DOSAGE/*THERAPEUTIC USE Drug Therapy, Combination HIV Infections/*COMPLICATIONS Human Minocycline/ADMINISTRATION & DOSAGE/*THERAPEUTIC USE Toxoplasmosis/COMPLICATIONS/*DRUG THERAPY ABSTRACT

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