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Antibiotics for human toxoplasmosis: a systematic review of randomized trials.
[congenital toxoplasmosis]
The
efficacy
of
different
treatment
regimens
in
clinical
syndromes
of
toxoplasmosis
were
assessed
by
conducting
a
systematic
review
of
published
randomized
clinical
trials
through
extensive
searches
in
MEDLINE
,
EMBASE
,
and
SCOPUS
with
no
date
limits
,
as
well
as
manual
review
of
journals
.
Outcome
measures
varied
depending
on
the
clinical
entity
of
toxoplasmosis
.
Risk
of
bias
was
evaluated
and
quality
of
evidence
was
graded
.
Fourteen
randomized
trials
were
included
of
which
one
was
a
non-comparative
study
.
One
well-designed
trial
showed
that
trimethoprim-sulphamethoxazole
was
more
effective
than
placebo
for
clinical
recovery
of
toxoplasmic
lymphadenopathy
in
immunocompetent
hosts
.
For
toxoplasmic
encephalopathy
,
efficacy
of
pyrimethamine
+
sulphadiazine
and
trimethoprim
+
sulphamethoxazole
were
similar
,
whereas
pyrimethamine
+
sulphadiazine
versus
pyrimathamine
+
clindamycin
showed
no
difference
,
irrespective
of
the
outcome
.
Intravitreal
clindamycin
+
dexamethasone
and
conventional
treatment
with
oral
pyrimethamine
+
sulphadiazine
had
similar
efficacy
with
regard
to
all
outcome
measures
in
ocular
toxoplasmosis
,
and
intravitreal
therapy
was
found
to
be
safe
.
Adverse
effects
seemed
more
common
with
pyrimethamine
+
sulphadiazine
.
Most
trials
for
encephalitis
and
ocular
manifestations
had
a
high
risk
of
bias
and
were
of
poor
methodological
quality
.
There
were
no
trials
evaluating
drugs
for
toxoplasmosis
in
pregnancy
,
or
for
congenital
toxoplasmosis
.
Pyrimethamine
+
sulphadiazine
is
an
effective
therapy
for
treatment
of
toxoplasmic
encephalitis
;
trimethoprim
+
sulphamethoxazole
and
pyrimethamine
+
clindamycin
are
possible
alternatives
.
Treatment
with
either
oral
or
intravitreal
antibiotics
seems
reasonable
for
ocular
toxoplasmosis
.
Overall
,
trial
evidence
for
the
efficacy
of
these
drugs
for
toxoplasmosis
is
poor
,
and
further
well-designed
trials
are
needed
.
Diseases
Validation
Diseases presenting
"lymphadenopathy in immunocompetent"
symptom
congenital toxoplasmosis
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