Treatment Options for the Eradication of Intestinal Protozoa

Michael JG Farthing


Nat Clin Pract Gastroenterol Hepatol. 2006;3(8) 

In This Article


Intestinal protozoa are responsible for considerable morbidity and mortality associated with diarrheal disease in both the developed and developing world. Many of these infections are particularly serious in individuals with impaired cell-mediated immunity, such as those with HIV/AIDS. The clinical impact of the intracellular intestinal protozoa (Cryptosporidium, Microsporidium, Cyclospora, Isospora spp.) in patients with HIV infection has, however, been dramatically reduced since the introduction of highly active antiretroviral therapy (also known as triple drug regimens). Although cryptosporidiosis has been a major clinical challenge, it can now be treated effectively with nitazoxanide, a substituted benzamide. Nitazoxanide treatment is also effective and safe in children. Co-trimoxazole can be used to treat patients infected with the relatively new pathogen, Cyclospora cayetanensis (and also Isospora belli infection). Microsporidiosis remains a therapeutic challenge. Clinical trials indicate that, although parasite eradication is not consistently achieved, albendazole and fumagillin are effective therapeutic options for the treatment of microsporidiosis.

In view of the importance of intestinal protozoa in the clinical course of patients with HIV, and the dramatic therapeutic effects of highly active antiretroviral therapy, it is vital that the availability of these drugs continues to increase in the developing world, especially in sub-Saharan Africa. Although progress has been made in antimicrobial chemotherapy for cryptosporidiosis and microsporidiosis, current treatments are by no means perfect and new agents with improved efficacy are required. Many of these organisms are spread in contaminated food and water and, therefore, worldwide public health interventions that control transmission remain vital.

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