Treatment Options for the Eradication of Intestinal Protozoa

Michael JG Farthing

Disclosures

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

In This Article

Cyclospora Cayetanensis

Cyclospora was first identified in the mid 1980s in individuals with persistent diarrhea who had a history of foreign travel[52] or were infected with HIV. Seasonal outbreaks have been described in Nepal among foreign residents and travelers, and a small outbreak has been reported in medical staff in a Chicago hospital. Transmission of Cyclospora has also been confirmed to occur through contaminated food, such as raspberries. Cyclospora cayetanensis causes persistent diarrhea in both immunocompetent and immunocompromised individuals. The diarrhea can last for 1–8 weeks and be associated with abdominal pain, nausea, vomiting and anorexia.[53,54]

The treatment of choice for C. cayetanensis infection is co-trimoxazole (sulfamethoxazole 800 mg and trimethoprim 160 mg) twice daily for 7 days.[55] This treatment regimen results in the eradication of infection in more than 90% of individuals; continuation of treatment for a further 3 days cures most of the remaining patients. Ciprofloxacin is less effective, but is suitable for patients who cannot tolerate co-trimoxazole.[56]

Co-trimoxazole is effective for chemoprophylaxis, but is usually only indicated in immunocompromised patients who experience frequent reinfections with Cyclospora spp. or in those who fail to clear Cyclospora infection by following the standard treatment regimen.

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