What is included in antiparasitic therapy for cryptosporidiosis?

Updated: Nov 11, 2019
  • Author: Melinda B Tanabe, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Nitazoxanide inhibits the growth of Cryptosporidium parvum and Giardia lamblia trophozoites. [50] It significantly shortens the duration of diarrhea and can decrease the mortality risk in malnourished children. [40] Trials have also demonstrated efficacy in adults. [51, 52] Trials of antiparasitic drugs in patients with AIDS and cryptosporidiosis have been disappointing. Nitazoxanide, paromomycin, and azithromycin are partially active. [53] It is administered in a 3-day, twice-daily course of tablets or oral suspension. [52, 54] In clinical trials, nitazoxanide significantly reduced the duration of diarrhea, increased the rate of parasitological eradication, and improved the mortality rate in malnourished children with Cryptosporidium infection who were HIV seronegative. [40] The most common adverse effects reported were abdominal pain, diarrhea, vomiting, and headache; adverse effects were not significantly different from those reported with a placebo. However, the use of nitazoxanide alone has not been successful in controlled trials in patients with AIDS. [40, 55] In patients with HIV/AIDS and renal transplant recipients, studies have proposed off–label prolonged courses.

No antiparasitic drug has been proven to reliably cure cryptosporidiosis in immunocompromised patients. In patients with AIDS, cryptosporidiosis usually cannot be eradicated prior to restoration of the CD4 cell count in response to combination antiretroviral therapy. [1, 56] During early immune reconstitution, patients should generally continue antiparasitic therapy (eg, nitazoxanide or paromomycin) and antimotility agents, as needed. In transplant recipients, reduction of immunosuppression, change from tacrolimus-based treatment to cyclosporine treatments, and combination antiparasitic therapy have proven satisfactory results. [1, 38]


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