Document 0782
 DOCN  M95A0782
 TI    [Treatment of toxoplasmosis retinochoroiditis with atovaquone in an AIDS
       patient]
 DT    9510
 AU    Schimkat M; Althaus C; Armbrecht C; Jablonowski H; Sundmacher R;
       Augenklinik, Heinrich-Heine-Universitat Dusseldorf.
 SO    Klin Monatsbl Augenheilkd. 1995 Mar;206(3):173-7. Unique Identifier :
       AIDSLINE MED/95341846
 AB    BACKGROUND: Treatment of ocular toxoplasmosis in HIV-infected patients
       with standard drug regimens (Pyrimethamine, Clindamycine, Sulfonamides)
       is very often complicated by side-effects and adverse reactions. On the
       other hand, maintenance therapy must be continued life long, because of
       the high recurrence rates. Atovaquone (Hydroxynaphthoquinon) is
       tolerated excellently and is very effective against tachyzoits of
       toxoplasma gondii and its cysts. PATIENT HISTORY AND CLINICAL FINDINGS:
       A 49-year-old homosexual man with AIDS developed an allergic rash after
       being treated with a course of Pyrimethamine and Clindamycine for
       unilateral, bifocal ocular toxoplasmosis for 13 days. Therapy with
       Atovaquone 3 x 750 mg/d was instituted and within 8 days the infiltrates
       healed leaving retinochorioidal scars. THERAPY AND CLINICAL COURSE:
       During maintenance therapy with Atovaquone (3 x 750 mg/d) two relapses
       occurred, the first after 2 months and the second after 8 months. The
       recurrences were successfully treated by increasing the dosage of
       Atovaquone to 4 x 750 mg/d and the addition of
       Trimethoprime/Sulfamethoxazol and Clindamycine/Pyrimethamine
       respectively. Reexposition was tolerated without an allergic reaction.
       Under maintenance therapy with Pyrimethamine the patient was free of
       recurrences for another 4 months until he died. CONCLUSIONS: Atovaquone
       is an effective and well tolerated substance for the treatment of ocular
       toxoplasmosis. In contrast to earlier reports, two recurrences occurred
       under maintenance therapy. It cannot be excluded that the patient was
       incomplient and did not take the tablets according to our prescription.
       Future clinical investigations have to control the efficacy of
       Atovaquone in the therapy of ocular toxoplasmosis.
 DE    Antiprotozoal Agents/*THERAPEUTIC USE  AIDS-Related Opportunistic
       Infections/DIAGNOSIS/*DRUG THERAPY  Case Report
       Chorioretinitis/DIAGNOSIS/*DRUG THERAPY  Dose-Response Relationship,
       Drug  Drug Administration Schedule  English Abstract  Fluorescein
       Angiography  Follow-Up Studies  Human  Male  Middle Age
       Naphthoquinones/*THERAPEUTIC USE  Toxoplasmosis, Ocular/DIAGNOSIS/*DRUG
       THERAPY  JOURNAL ARTICLE

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