Macrolides

Three new macrolides: azithromycin, roxithromycin, and clarithromycin, have all shown activity in animal models of toxoplasmosis (Chang and Pechere 1988; Derouin 2000). The AIDS Clinical Trials Group has recently completed a prospective multicentre study of Azithromycin 1200mg/day in combination with 50-75mg pyrimethamine. The results were favourable (Mariuz et al. 1994). In another case report Farthing et al. (1992) describes a dramatic response to azithromycin in a patient with Toxoplasma encephalitis who was allergic to sulfonamide and in whom clindamycin and doxycycline were ineffective. The advantage of azithromycin is the high tissue penetration and the concentration within fibroblast and phagocytic cells. This could be useful in eradicating intracellular parasites and parasites in the cystic stage. Azithromycin has been used during pregnancy, the concentration in the placenta is up to 90-fold higher than the plasma level of the mother (Stray-Pedersen 1996).

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