Microsporidiosis Medication

Updated: Oct 05, 2015
  • Author: Valda M Chijide, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Medication

Medication Summary

Albendazole is the drug of choice for ocular, intestinal, and disseminated microsporidiosis. Albendazole has been shown to abate gastrointestinal symptoms, histopathologic evidence of clearance in the intestine, and weight gain in patients with E intestinalis infection. No consistently effective therapies exist for E bieneusi infection. Albendazole is reported to reduce frequency and volume of diarrhea and stabilize the weight of patients with E bieneusi infection in some studies, but this is not associated with clearance of the organism on stool specimens or duodenal biopsy specimens. Metronidazole was associated with a good clinical response in patients with AIDS who had E bieneusi enteritis in a few reports, but the parasite was not eradicated. Most studies have not found metronidazole to be efficacious against microsporidiosis.

Topical fumagillin is used to treat microsporidial keratoconjunctivitis. This may elicit a clinical response in as little as 1 week, but long-term use is usually required to prevent recurrence. Oral fumagillin is useful in the treatment of E bieneusi infection but is associated with thrombocytopenia.

One study found that thalidomide treatment once per month decreased stool frequency and improved weight in patients with HIV infection but did not significantly decrease fecal levels of tumor necrosis factor alpha (TNF-alpha), which are typically elevated in persons with microsporidiosis. [13] Because of the significant toxicity of thalidomide, consider it only in microsporidiosis cases that have failed other treatments. Thalidomide has no known direct antimicrobial action but has been shown to selectively inhibit TNF-alpha in a monocytic cell line.

Improved immune function due to antiretroviral therapy seems to lead to normalization of intestinal architecture, clearance of parasites in the stool, and clinical improvement.

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Anthelmintics

Class Summary

Parasite biochemical pathways are sufficiently different from the human host to allow selective interference by chemotherapeutic agents in relatively small doses.

Albendazole (Albenza)

A benzimidazole carbamate drug that appears to cause selective degeneration of cytoplasmic microtubules in intestinal and tegmental cells of intestinal helminths and their tissue-dwelling larvae. Converted in the liver to its primary metabolite, albendazole sulfoxide. Less than 1% of the primary metabolite is excreted in the urine. Used in symptomatic patients with diarrhea or disseminated disease.

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Antibiotics

Class Summary

Therapy should cover all likely organisms in the context of the clinical setting.

Fumagillin (Fumidil)

An antiangiogenesis factor consisting of an antibiotic derived from Aspergillus fumigatus that exerts its effect by binding to the metalloprotease methionine aminopeptidase type 2. Effective for ocular lesions demonstrated to be caused by microsporidia, especially Encephalitozoon species. The Food and Drug Administration (FDA) has not approved fumagillin for microsporidiosis. It is available in the United States and can be obtained by calling 1-800-547-1392.

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Immunomodulators

Class Summary

These agents modulate key factors of the immune system.

Thalidomide (Thalomid)

A toxic drug with immunosuppressive effects that is used for various immune-mediated conditions. Also, used for chronic diarrhea unresponsive to albendazole or other therapies.

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Antiprotozoals

Class Summary

These agents are used in symptomatic patients with diarrhea.

Metronidazole (Flagyl, Protostat)

Oral synthetic drug with antiprotozoal and antibacterial action.

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