Cyclosporiasis medical therapy

Trimethoprim-sulfamethoxazole (TMP-SMX), or Bactrim, Septra, or Cotrim, is the treatment of choice. Most people who have healthy immune systems will recover without treatment. If not treated, the illness may last for a few days to a month or longer. Symptoms may seem to go away and then return one or more times (relapse). Anti-diarrheal medicine may help reduce diarrhea, but a health care provider should be consulted before such medicine is taken. People who are in poor health or who have weakened immune systems may be at higher risk for severe or prolonged illness.^[1]

• Trimethoprim-sulfamethoxazole (TMP-SMX), or Bactrim, Septra, or Cotrim, is the treatment of choice. The typical regimen for immunocompetent adults is TMP 160 mg plus SMX 800 mg (one double-strength tablet), orally, twice a day for 7-10 days. This regimen is shown to decrease the shedding of ova in stool and this corresponds to signs of clinical improvement.^[2]
• HIV-infected patients may need longer courses of therapy.
• No highly effective alternatives have been identified for persons who are allergic to (or are intolerant of) TMP-SMX. Approaches to consider for such persons include observation and symptomatic treatment, use of an antibiotic whose effectiveness against Cyclospora is unknown or is based on limited data, or desensitization to TMP-SMX. The latter approach should be considered only for selected patients who require treatment, have been evaluated by an allergist, and do not have a life-threatening allergy. Ciprofloxacin has been shown to be effective in treating patients with sulpha allergy however treatment failures have also been reported. Nitazoxanide for 7 days have shown beneficial as an alternative regimen in patients with sulfa allergy.^[2]
• Anecdotal or unpublished data suggest that the following drugs are ineffective: albendazole, trimethoprim (when used as a single agent), azithromycin, nalidixic acid, tinidazole, metronidazole, quinacrine, tetracycline, doxycycline, and diloxanide furoate. Although data from a small study among HIV-infected patients in Haiti suggested that ciprofloxacin might have modest activity against Cyclospora, substantial anecdotal experience among many immunocompetent persons suggests that ciprofloxacin is ineffective.
• Use of trade names is for identification only and does not imply endorsement by the Public Health Service or by the U.S. Department of Health and Human Services.^[3]

• The safety threshold of trimethoprim-sulfamethoxazole (TMP-SMX) in children is not completely understood.
• It is not recommended in infants of less than 2 months of age.

• A category C pregnancy drug, trimethoprim-sulfamethoxazole (TMP-SMX) should be only used in pregnant patients if the potential benefits justifies potential risks to the patient. TMP-SMX should be avoided near-term because of the potential for hyperbilirubinemia and kernicterus in the newborn.

• Trimethoprim-sulfamethoxazole (TMP-SMX) is excreted in breast milk. So women should avoid trimethoprim-sulfamethoxazole (TMP-SMX) during the nursing period of infants with following conditions.

• Premature
• Jaundice
• Ill
• Glucose 6 phosphate dehydrogenase deficiency

• However it is generally compatible during the lactation period of healthy new born infants after new born period.

• Higher doses of trimethoprim-sulfamethoxazole (TMP-SMX) (160 mg and 800 mg PO four times a day for 10 days) are required to treat HIV patients followed by trimethoprim-sulfamethoxazole 3 times a week as a prophylaxis to prevent relapse.^[4]

• Cyclospora cayetanensis^[5]

• Preferred regimen: Trimethoprim-sulfamethoxazole one double-strength tablet PO bid for 7-10 days
• Alternative regimen(1): Ciprofloxacin 500 mg PO bid for 7 days
• Alternative regimen(2): Nitazoxanide 500 mg PO bid for 7 days
• Note(1): One double-strength tablet (160 mg TMP/800 mg SMX) .
• Note(2): Treatment is continued for 7 days in immunocompetent hosts and for 7 to 10 days in patients with HIV infection.