Adverse Cutaneous Reactions to Pyrimethamine/Sulfadiazine and Pyrimethamine/Clindamycin in Patients with AIDS and Toxoplasmic Encephalitis

• Published in: Clinical infectious diseases 1995-09, Vol.21 (3), p.656-658
• Main Authors: Caumes, Eric, Bocquet, Hélène, Guermonprez, Géraldine, Rogeaux, Olivier, Bricaire, François, Katlama, Christine, Gentilini, Marc
• Format: Article
• Language: English
• Subjects: Adult; AIDS; AIDS-Related Opportunistic Infections - drug therapy; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - adverse effects; Anti-Infective Agents - administration & dosage; Anti-Infective Agents - adverse effects; Biological and medical sciences; Clindamycin - administration & dosage; Clindamycin - adverse effects; Corticosteroids; Dosage; Drug Eruptions - etiology; Drug Therapy, Combination; Drug toxicity and drugs side effects treatment; Encephalitis; Encephalitis - complications; Encephalitis - drug therapy; Exanthema; Female; Humans; Hypersensitivity; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Pyrimethamine - administration & dosage; Pyrimethamine - adverse effects; Retrospective Studies; Risk Factors; Side effects; Skin; Stevens-Johnson Syndrome - etiology; Sulfadiazine - administration & dosage; Sulfadiazine - adverse effects; Toxic epidermal necrolysis; Toxicity: skin, dermoskeleton; Toxoplasmosis; Toxoplasmosis, Cerebral - complications; Toxoplasmosis, Cerebral - drug therapy
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/clinids/21.3.656

We assessed the value of clinical and laboratory parameters for predicting the occurrence of skin reactions induced by pyrimethamine/sulfadiazine and pyrimethamine/clindamycin and the effects of continued therapy for patients with these reactions. We retrospectively studied all episodes of toxoplasmic encephalitis in patients with AIDS who were treated with pyrimethamine/sulfadiazine or pyrimethamine/clindamycin. Eighteen (75%) of 24 patients treated with pyrimethamine/sulfadiazine had cutaneous reactions after a mean of 11 days, whereas 15 (58%) of 26 patients treated with pyrimethamine/clindamycin had cutaneous reactions after a mean of 13 days (P = .56). Nine (50%) of the 18 patients continued to be treated with pyrimethamine/sulfadiazine throughout the duration of hypersensitivity, compared with all 15 patients who were treated with pyrimethamine/clindamycin (P = .002). Nine patients had to stop therapy with pyrimethamine/sulfadiazine (two had Stevens-Johnson syndrome and one had Lyell's syndrome). Thus, treatment throughout the duration of hypersensitivity is more likely to succeed for patients receiving pyrimethamine/clindamycin, whereas therapy with pyrimethamine/sulfadiazine is associated with a high risk of Lyell's syndrome and Stevens-Johnson sydrome.