Cryptosporidiosis medical therapy

Medical management of Cryptosporidium infection includes supportive care, symptomatic management and prompt initiation of antiretroviral therapy.

Medical management of Cryptosporidium infection includes supportive care, symptomatic management and prompt initiation of antiretroviral therapy. The principles of therapy include the following:
Preferred Management Strategies:^[1]

• Initiate or optimize ART for immune restoration to CD4 count >100 cells/mm3 OR
• Aggressive oral and/or IV rehydration and replacement of electrolyte loss OR
• Symptomatic treatment of diarrhea with anti-motility agent OR
• Tincture of opium may be more effective than loperamide

Alternative Management Strategies:

• Nitazoxanide 500–1000 mg PO BID with food for 14 days + optimized ART, symptomatic treatment, and rehydration and electrolyte replacement, OR
• Paromomycin 500 mg PO QID for 14 to 21 days + optimized ART, symptomatic treatment and rehydration and electrolyte replacement

• Supportive management of diarrhea should be by advising patients to drink plenty of fluids to prevent dehydration. People who are in poor health or who have weakened immune systems are at higher risk for more severe and prolonged illness. Young children and pregnant women may be more susceptible to dehydration resulting from diarrhea and should drink plenty of fluids while ill. Rapid loss of fluids from diarrhea may be especially life threatening to babies. Therefore, parents should talk to their health care providers about fluid replacement therapy options for infants.
• Symptomatic therapy with anti-motility agents and a tincture of opium are preferred over loperamide.
• Nitazoxanide has been FDA-approved for treatment of diarrhea caused by Cryptosporidium in people with healthy immune systems and is available by prescription. However, the effectiveness of nitazoxanide in immunosuppressed individuals is unclear.
• HIV-positive individuals who suspect they have cryptosporidiosis should contact their health care provider. For those persons with AIDS, anti retroviral therapy that improves the immune status will also decrease or eliminate symptoms of cryptosporidiosis. However, even if symptoms disappear, cryptosporidiosis is often not curable and the symptoms may return if the immune status worsens.

• Immunocompetent patients^[2]
  • Preferred regimen: No specific therapy recommended since healthy patients usually recover within a few weeks, but if needed: Nitazoxanide 500 mg PO bid for 3 days.
• HIV positive patients^[3]

• Preferred regimen: Nitazoxanide 500 mg PO bid for 3 days

• HIV infection and with severe immunosuppression^[4]

• No pharmacologic or immunologic therapy directed against Cryptosporidium has been shown to be consistently effective when used without antiretroviral therapy.
• In patients with severe immunosuppression antiretroviral therapy must be initiated immediately and the goal for CD4 cells should be targeted for a value greater than 100cells/mm³. This alone will result in the resolution of the clinical symptoms.
• Note: Nitazoxanide is not licensed for immunodeficient patients.
• All the patients must be monitored closely for signs and symptoms of volume depletion, electrolyte imbalance, weight loss, and malnutrition.
• Total parenteral nutrition or repletion of electrolytes by intravenous route may be indicated in patients certain patients with severe diarrhea can exceeding >10 L/day.

• Supportive treatment and optimization of ART to achieve full virologic suppression are the only feasible approaches to managing treatment failure.

• Rehydration and initiation of ART are the mainstays of initial treatment of cryptosporidiosis during pregnancy, as they are in non-pregnant women.
• Nitazoxanide can be used in pregnancy after the first trimester in women with severe symptoms.
• Loperamide should be avoided in the first trimester, unless benefits are felt to outweigh potential risks.
• Opiate exposure is associated with neonatal respiratory depression, and chronic exposure may result in neonatal withdrawal, therefore not indicated for symptomatic treatment.

http://www.cdc.gov/parasites/crypto/treatment.html

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