Désensibilisation accélérée à la clindamycine de patients sidéens traités pour une toxoplasmose cérébrale

Abstract

Summary The use of pyrimethamine plus clindamycine has been validated as an effective treatment of toxoplasmic encephalitis in AIDS patients : this combination was assessed in 21 patients (10 in first intention therapy, 11 as an alternative regimen to pyrimethamine plus sulfadiazine). In the ten first days of treatment 7 patients experienced a mild to severe skin rash with fever which resolved after discontinuation of clindamycin. A one-day specific desensitization regimen was completed under careful monitoring : the initial dose of intravenous clindamycine was 0,15 mg. The dosage was two-fold increased every hour so as to get the 1,2 g unit dose after 18 hours. In 6 of the 7 patients the clinical tolerance of the regimen was good and the pyrimethamine-clincamycin combination could so be completed not only for acute but also for maintenance therapy. On the other hand, in one patient, the occurrence of a new rash during the desensitization led us to stop the test. These data suggest that rush desensitization to clindamycin could be used to allow AIDS patients who experienced clindamycin related skin rash to complete bitherapy regimen of toxoplasmic encephalitis.