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October 1992

Empiric Treatment of Acute Toxoplasma Encephalitis in Patients With Acquired Immunodeficiency Syndrome-Reply

Arch Intern Med. 1992;152(10):2140. doi:10.1001/archinte.1992.00400220141027

In Reply.—  We would like to thank Iribarren and colleagues for their comments on our article.1 Patients in our series were treated with pyrimethamine (25 to 50 mg/d) and sulfadiazine at (1 to 4 g/d) in divided doses. These regimens were within the accepted guidelines for treatment of toxoplasmosis at the time of our study.2,3We recommend caution in interpreting the observation that one third of patients with toxoplasmosis did not respond to toxoplasmosis therapy. As indicated in our article, failure to respond to empiric therapy for toxoplasmosis was a criterion for performing a biopsy. Patients who were labeled "nonresponders" received drug therapy for 10 to 14 days prior to biopsy. Some of these patients may have responded if they had been given higher doses or a longer course of treatment. Our study was not designed to evaluate the efficacy of empiric treatment but to evaluate the variables