PYRIMETHAMINE-SULFADOXINE TREATMENT OF CONGENITAL TOXOPLASMOSIS - FOLLOW-UP OF 78 CASES BETWEEN 1980 AND 1997

The purpose of this study was to determine the clinical and immunologi cal outcome of 78 children with congenital toxoplasmosis treated with the pyrimethamine-sulfadoxine combination between 1980 and 1997. Metho ds. Children were divided into 3 groups according to the initial durat ion of treatment (always including folinic acid, 5 mg/week by mouth), as follows: pyrimethamine (1.25 mg/kg every 15 d)+ sulfadoxine (25 mg/ kg every 15 d) for 12 months (Group 1, 47 children), or for 24 months, with or without prenatal therapy (respectively, Group 2, 19 children, and Group 3, 12 children). Results. Chorioretinitis occurred in 23% o f these 78 children. Four children had unilateral blindness, 1 had mil d epileptic fits and 1 had psychomotor retardation. The lowest rate of sequelae were in Groups 2 and 3. Immunological rebounds, generally wi thout clinical repercussions, occurred frequently (90% of cases on ave rage) during, or more often after therapy, regardless of the treatment duration. Treatment was always well tolerated. Conclusions. Our curre nt treatment strategy for congenital toxoplasmosis consists of a 24-mo nth course of pyrimethamine-sulfadoxine (Fansidar(R)) combined with fo linic acid (Lederfoline(R)), If the prenatal diagnosis is positive, we also prescribe this treatment to the mother until delivery, This comb ination offers satisfactory compliance, adequate serum concentrations, and good preventive efficacy.