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Cotrimoxazole Prophylaxis for Toxoplasmosis
- Andrew Carr, MD;
- Brett Tindall, MD; and
- David A. Cooper, MD
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IN RESPONSE:
Dr. Caumes and colleagues report a retrospective study involving five presumably compliant patients who received trimethoprim-sulfamethoxazole (160 mg/800 mg) and still developed toxoplasmic encephalitis. They also refer to two recent studies that found one tablet given three times a week to be ineffective (although the abstract contains no data to support this conclusion) [1] and one tablet given twice daily to be effective but too toxic [2]. We agree that one tablet twice daily is far too toxic for many patients. Nevertheless, no study has shown a weekly dose of seven tablets to be more effective than four tablets given over the same period, although the former dose could quite possibly incur greater toxicity. Indeed, we have seen only one definite case of toxoplasmic encephalitis since mid-1987 in any patient receiving our regimen of trimethoprim-sulphamethoxazole (in addition to the one possible case reported) [3], from a total of 85 cases. It is even possible that one tablet twice daily given 2 days per week is actually more effective than one tablet daily by achieving higher peak serum levels with reduced incidence of resistance. Before endorsing any one dose of trimethoprim-sulfamethoxazole as a “best compromise” or assuming that more is better, comparative studies of different doses of trimethoprim-sulfamethoxazole are needed.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
