Ocular toxoplasmosis

The combination of pyrimethamine and sulfonamide has been recommended for treatment of active chorioretinitis. Therapy is usually administered for at least 1 month, and improvement is generally noticed after 10 days. Longer treatment may be given if active infection persists. Due to side effects ophthalmologists have tried to replace pyrimethamine with clindamycin (300mg orally, four times a day) (Lackanpal et al. 1983). Systemic cortiocsteroids are added when lesions involve the macula, optic nerve head, or papillomacular bundle. Overall, the benefits of treating Toxoplasma chorioretinitis are not too favourable. A European controlled trial by Rothova et al. (1989) found that none of the treatment regimes reduced the duration of inflammatory activity in comparison to untreated patients. Pyrimethamine and sulfadiazine significantly reduced the size of the retinal lesions by 52% compared to 25% in controls, while clindamycin, together with sulfadiazine, showed marginal improvement (32%) and cotrimoxazol were ineffective. In all regimes corticosteroides were added. Therapy is today advocated only if the central visual function is threatened either by local or general inflammation, while peripheral retinal pathology is usually allowed to resolve spontaneously under observation (Dutton 1989a,b). At present, the choice of treatment is between sulfonamides and pyrimethamine or clindamycin. Previously pyrimethamine was the drug of choice, but most recent studies are in favour of the clindamycin combination (Dutton 1989a,b). Sub-conjunctival treatment has shown to be effective (Jeddi et al. 1997).

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