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
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
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
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
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