Journal of Clinical and Experimental Ophthalmology
Open Access

Abstract

Atovaquone: A Valuable Therapeutic Option in Toxoplasma Retinochoroiditis

Alexander Reis, Christophe Valmaggia, Tamer Tandogan, Karoline Rippel and Olja Girmann

Background: Toxoplasma gondii is a leading cause of severe foodborne illness in first world countries and the most common cause of posterior uveitis. Neither a standard treatment protocol has been established so far, nor has the efficacy of the mostly applied medications and their combinations be proven in well-designed clinical trials. Atovaquone, a hydroxy-1,4-naphtoquinone, is a safe and effective treatment against tachyzoites and cyst forms of Toxoplasma, but it is only FDA and EMEA approved for the treatment of pneumocystis infections. We have started using Atovaquone in ocular toxoplasmosis on a regular, off-label basis in 1996.
Methods: We report about the use of Atovaquone 750 mg twice daily in punctate outer retinal toxoplamosis as well as in Toxoplasma retinochoroiditis resistant to four different antibiotics.
Results: Toxoplasma activity stopped within three weeks of Atovaquone therapy without any side-effects.
Conclusions: In our hands the three-week Atovaquone treatment is a safe and efficient therapeutic option in ocular toxoplasmosis. Placebo-controlled randomized trials of anti-Toxoplasma treatment in patients presenting with Toxoplasma retinochoroiditis are required. These trials should include Atovaquone.