[Clindamycin therapy of suspected toxoplasmosis retinochoroiditis]

It is generally accepted that toxoplasmic retinochorioiditis should be treated when central visual function is threatened. Although controlled trials of treatment led to contradictory results, a combination of pyrimethamin, sulphadiazine and folinic acid is regarded to be the most effective treatment strategy. Nevertheless, hematological complications necessitate a discontinuation of these drugs in up to 1/4 of the patients. Clindamycin, a semisynthetic antibiotic, also has an antitoxoplasmal effect on animals and is less toxic to the bone marrow. A theoretical advantage is that Clindamycin can penetrate and act on the encysted form of the parasite and that it will accumulate in the uveal tissue of the eye. Between 1983 and 1991 we performed 102 courses of treatment in 90 patients with presumed toxoplasmic retinochorioiditis. 900-1800 mg Clindamycin were given in combination with 60-80 mg Fluorcortolon which was gradually decreased during a 4 to 6 week period. In general Clindamycin was given for 6 weeks. Duration varied from 4 to 12 weeks. 15 patients experienced side effects of treatment. 6 of them complained of diarrhea and gastrointestinal bleeding and 7 patients developed allergic exanthem and acne. Mild lymphopenia and hepatotoxicity were further complications. In 8 patients the drugs had to be discontinued; 4 times for gastrointestinal discomfort, 3 times for allergic exanthem and in one patient for mild hepatotoxicity. We did not observe any serious complications during therapy. Only 9 complications were attributable to clindamycin, they disappeared immediately after discontinuing treatment.