Medication Summary
Studies of healthy hosts and malnourished children have demonstrated the importance of nitazoxanide treatment.[12, 17]
Since the advent of combination antiretroviral therapy, cryptosporidiosis is much less common in persons with AIDS. Patients not receiving combination antiretroviral therapy need to be stabilized with the drugs described below before starting HIV treatment.
Antiparasitic drugs aim to treat diarrhea by a direct anticryptosporidial effect, but maintenance treatment is often required. Antimotility agents are administered to relieve symptoms and to increase exposure to the antiparasitic and antiretroviral agents. Somatostatin analogues are partially beneficial for reducing secretory diarrhea in some refractory cases.
Antiparasitic Drugs
Class Summary
Nitazoxanide,[18] paromomycin, and azithromycin have activity against Cryptosporidium.
Paromomycin
This is an oral, nonabsorbed aminoglycoside that is partially active in cryptosporidiosis. It is an amebicidal and antibacterial aminoglycoside obtained from a strain of Streptomyces rimosus that is active in intestinal amebiasis. Paromomycin is recommended for treatment of Diphyllobothrium latum, Taenia saginata, Taenia solium, Dipylidium caninum, and Hymenolepis nana.
Azithromycin (Zithromax, Zmax)
Azithromycin is a macrolide antibiotic. In a clinical study, it provided good symptom control in combination with paromomycin.
Nitazoxanide (Alinia)
Nitazoxanide inhibits the growth of Cryptosporidium parvum sporozoites and oocysts and Giardia lamblia trophozoites. It elicits antiprotozoal activity by interfering with pyruvate-ferredoxin oxidoreductase (PFOR) enzyme–dependent electron transfer reaction, which is essential to anaerobic energy metabolism.
Antidiarrheal Agents
Class Summary
These agents are used to decrease the frequency of diarrheal stools and possibly the duration of episodes.
Loperamide hydrochloride (Imodium, Diamode, Kao Paverin)
This agent has an antimotility effect on the GI tract via cholinergic and opiate receptors. It is the first choice as an antidiarrheal agent. Loperamide hydrochloride has a more potent effect than diphenoxylate hydrochloride or codeine. It acts on intestinal muscles to inhibit peristalsis and slow intestinal motility. The drug prolongs the movement of electrolytes and fluid through bowel, increases viscosity, and decreases the loss of fluids and electrolytes.
Diphenoxylate and atropine (Lomotil)
This is a pethidine analogue that reduces intestinal motility but that is not as effective as loperamide hydrochloride. The drug combination consists of diphenoxylate, which is a constipating meperidine congener, and atropine, which discourages abuse; it inhibits excessive GI propulsion and motility.
Paregoric
More potent opiates (anhydrous morphine) can decrease motility more than is achieved by loperamide or by the combination of diphenoxylate and atropine.
Somatostatin Analogues
Class Summary
These agents inhibit the secretion of hormones involved in vasodilation.
Octreotide (Sandostatin)
Octreotide is a synthetic octapeptide analogue of somatostatin. It inhibits the secretion of multiple endocrine hormones. Octreotide acts primarily on somatostatin receptor subtypes II and V. It inhibits GH secretion and has a multitude of other endocrine and nonendocrine effects, including the inhibition of glucagon, VIP, and GI peptides. Its efficacy has not been proven.
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