- Author: Miguel M Cabada, MD, MSc; Chief Editor: Michael Stuart Bronze, MD more...
As previously stated, supportive therapy is the key component in the management of cryptosporidiosis. Replacement of fluids and electrolytes is the critically important first step in the management of this diarrheal illness. Oral rehydration is the preferred mode, but severely ill patients may require parenteral fluids.
A 3-day course of nitazoxanide oral suspension has been approved by the US Food and Drug Administration (FDA) for the treatment of cryptosporidiosis-related diarrhea in adults and in children older than 12 months.[21, 26, 27] In clinical trials, the agent significantly reduced the duration of diarrhea caused by Cryptosporidium infections.
Nitazoxanide also reduced the rate of death in malnourished children in Africa with Cryptosporidium infection. The most common adverse effects reported were abdominal pain, diarrhea, vomiting, and headache; adverse effects were not significantly different from those reported with a placebo. However, the use of nitazoxanide alone has not been successful in controlled trials in patients with AIDS.[21, 34]
In patients with AIDS, antiretroviral treatment has been associated with improvement, possibly because of general improvement of immune function.[1, 10, 31]
Nitazoxanide, paromomycin, and azithromycin have activity against Cryptosporidium. Paromomycin alone or with azithromycin is minimally effective (although paromomycin did reportedly cause symptomatic improvement but rarely parasite eradication). In patients with HIV infection, improvement in the CD4 cell count with antiretroviral therapy can improve the course of disease.
Nitazoxanide inhibits the growth of Cryptosporidium parvum 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. A 3-day course of nitazoxanide oral suspension has been approved by the FDA for the treatment cryptosporidiosis-related diarrhea in adults and in children older than 12 months.
This is an oral, nonabsorbed aminoglycoside that is partially active in cryptosporidiosis. An amebicidal and antibacterial agent, it is obtained from a strain of Streptomyces rimosus that is active in intestinal amebiasis. Paromomycin is recommended for the treatment of Diphyllobothrium latum, Taenia saginata, T solium, Dipylidium caninum, and Hymenolepis nana.
Paromomycin has been used in patients who have AIDS and cryptosporidiosis; it was reported to cause symptomatic improvement but rarely parasite eradication.
Azithromycin is a macrolide antibiotic. In a clinical study, it provided good symptom control in combination with paromomycin.
These agents are used to decrease the frequency of diarrheal stools and possibly the duration of episodes.
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.
The drug combination consists of diphenoxylate, which is an opiate constipating meperidine congener, and atropine, which an anticholinergic drug that inhibits excessive GI propulsion and motility.
The opiate anhydrous morphine, which is contained in paregoric, can decrease motility more than loperamide or the combination of diphenoxylate and atropine can.
This agent exerts antisecretory and antibacterial effects to control diarrhea.
Attapulgite is an adsorbent and protectant that controls diarrhea.
These agents inhibit the secretion of hormones involved in vasodilation. Octreotide (Sandostatin) may help, but no solid data show superiority over other antimotility agents and it is expensive.
Octreotide primarily acts on somatostatin receptor subtypes II and V. It inhibits growth hormone secretion and has a multitude of other endocrine and nonendocrine effects, including inhibition of glucagon, vasoactive intestinal peptide (VIP), and GI peptides.
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