What are the key component in the treatment of cryptosporidiosis?

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

Supportive therapy is the key component in the management of cryptosporidiosis. Replacement of fluids and electrolytes is the critically important first step in the management of this diarrheal illness. Oral rehydration is the preferred mode, but severely ill patients may require parenteral fluids.

Nitazoxanide, paromomycin, and azithromycin have activity against Cryptosporidium. [1] A 3-day course of nitazoxanide oral suspension has been approved by the FDA for the treatment of cryptosporidiosis-related diarrhea in adults and in children older than 12 months who do not have HIV infection. In patients with AIDS, antiretroviral treatment has been associated with improvement, possibly because of general improvement of immune function. [56] Paromomycin alone or with azithromycin is minimally effective (although paromomycin has been found to improve symptoms but rarely eradicates parasites) but may facilitate improvement in response to antiretroviral therapy. In solid organ transplant recipients, studies have shown that the heterogeneity of its prevalence varies by type of immunosuppression. In renal transplant recipients, for example, cyclosporine-based regimens were associated with a lower incidence of Cryptosporidium infections than tacrolimus-based regimens. [58] Treatment may require prolonged courses of nitazoxanide or combination therapy plus reduction of immunosuppression. [38] Mofetil mycophenolate may affect Cryptosporidium by inhibiting folate metabolism, although this theory has not been confirmed.

Several novel compounds are being developed with efficacy in animal models. [59] For example, clofazimine is currently being studied in a randomized clinical trial in patients with AIDS. [60] Clofazimine accumulates within the epithelial cells of the intestine, acting as a potential target for Cryptosporidium. [61] With proven in vitro activity, clofazimine has yet to show results in randomized control trials, which is currently being studied in Africa. [60]


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