ADVERSE CUTANEOUS REACTIONS TO PYRIMETHAMINE SULFADIAZINE AND PYRIMETHAMINE CLINDAMYCIN IN PATIENTS WITH AIDS AND TOXOPLASMIC ENCEPHALITIS

We assessed the value of clinical and laboratory parameters for predic ting the occurrence of skin reactions induced by pyrimethamine/sulfadi azine and pyrimethamine/clindamycin and the effects of continued thera py for patients with these reactions. We retrospectively studied all e pisodes of toxoplasmic encephalitis in patients with AIDS who were tre ated with pyrimethamine/sulfadiazine or pyrimethamine/clindamycin. Eig hteen (75%) of 24 patients treated with pyrimethamine/sulfadiazine had cutaneous reactions after a mean of 11 days, whereas 15 (58%) of 26 p atients treated with pyrimethamine/clindamycin had cutaneous reactions after a mean of 13 days (P = .56). Nine (50%) of the 18 patients cont inued to be treated with pyrimethamine/sulfadiazine throughout the dur ation of hypersensitivity, compared with all 15 patients who were trea ted with pyrimethamine/clindamycin (P = .002), Nine patients had to st op therapy with pyrimethamine/sulfadiazine (two had Stevens-Johnson sy ndrome and one had Lyell's syndrome), Thus, treatment throughout the d uration of hypersensitivity is more likely to succeed for patients rec eiving pyrimethamine/clindamycin, whereas therapy with pyrimethamine/s ulfadiazine is associated with a high risk of Lyell's syndrome and Ste vens-Johnson sydrome.