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Brian R. Dannemann, MD; Dennis M. Israelski, MD; Jack S. Remington, MD

Arch Intern Med. 1988;148(11):2477-2482.

Abstract
• At present, therapy for toxoplasmic encephalitis (TE) is the combination of pyrimethamine with sulfadiazine or trisulfapyrimidines. Unfortunately, due to adverse reactions to sulfonamides, many patients with acquired immunodeficiency syndrome (AIDS) are unable to receive a complete course of therapy. The promising results with clindamycin phosphate therapy in a mouse model of TE prompted us to seek further information about patients with AIDS with TE who had been treated with clindamycin. Fifteen such patients were identified in whom clindamycin was used to treat 18 episodes of TE. Eleven patients showed clinical or radiologic improvement after receiving clindamycin therapy, either alone or in combination with pyrimethamine. Twelve received oral clindamycin as suppressive therapy after discharge from the hospital. Adverse reactions possibly related to clindamycin therapy included diarrhea, reversible granulocytopenia, and skin reactions. The results of this retrospective study suggest that clindamycin, either alone or in combination with pyrimethamine, may represent an effective alternative therapy for TE in patients with AIDS. Whether this supposition can be substantiated by appropriately designed studies is presently being determined.

(Arch Intern Med 1988;148:2477-2482)

Author Affiliations
From the Department of Immunology and Infectious Diseases, Research Institute, Palo Alto (Calif) Medical Foundation, and the Division of Infectious Diseases, Department of Medicine, Stanford (Calif) University School of Medicine.

Footnotes
Accepted for publication May 31, 1988.

Reprint requests to the Research Institute, Palo Alto Medical Foundation, Palo Alto, CA 94301 (Dr Remington).

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