Pediatric Cryptosporidiosis Medication

  • Author: Jaya Sureshbabu, MBBS, DCh, MRCPCH(UK), MRCPI(Paeds), MRCPS(Glasg), DCH(Glasg); Chief Editor: Russell W Steele, MD   more...
 
Updated: Jun 15, 2011
 

Medication Summary

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.

Pharmaceutical treatment is not satisfactory. Many agents have been tried, with variable and limited success.

In December 2002, the US Food and Drug administration (FDA) approved nitazoxanide (Alinia) as an oral suspension to treat children with diarrhea caused by Cryptosporidium.[4, 19] A short, 3-day course of the suspension (100 mg/5 mL) was approved in children aged 1-11 years. In clinical trials, the agent significantly reduced the duration of diarrhea caused by Cryptosporidium infections. It 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.

Orally administered human serum immunoglobulin or bovine colostrum has been used successfully in several anecdotal reports.

In patients with AIDS, antiretroviral treatment has been associated with improvement, possibly because of general improvement of immune function.[12, 19, 20, 21] Combination therapy with paromomycin and azithromycin[22] for 4 weeks followed by paromomycin monotherapy for 8 wk has been successfully used in adult patients with AIDS. Clarithromycin has also shown activity in vitro and in animal studies, but only limited data on treatment of human cryptosporidiosis is available.

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Antidiarrheal agents

Class Summary

These are used to adjunctly treat diarrhea with rehydration therapy to correct fluid and electrolyte depletion. They may provide temporary relief for some patients.

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Bismuth subsalicylate (Pepto-Bismol, Bismatrol)

 

This agent exerts antisecretory and antimicrobial effects to control diarrhea.

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Attapulgite

 

Attapulgite is an adsorbent and protectant that controls diarrhea.

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Somatostatin Analogues

Class Summary

These agents inhibit the secretion of hormones involved in vasodilation. Octreotide (Sandostatin) may help but is expensive.

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Octreotide (Sandostatin)

 

Octreotide primarily acts on somatostatin receptor subtypes II and V. It inhibits GH secretion and has a multitude of other endocrine and nonendocrine effects, including inhibition of glucagon, VIP, and GI peptides.

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Antimicrobial agents

Class Summary

A 3-day course of nitazoxanide oral suspension has been approved by the FDA for treatment of children older than 12 months and adults with diarrhea due to cryptosporidiosis. Paromomycin alone or with azithromycin is minimally effective. No specific treatment is necessary for patients who are immunocompetent. In patients with HIV infection, improvement in CD4 cell count with antiretroviral therapy can improve the course of disease.

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Nitazoxanide (Alinia)

 

Nitazoxanide inhibits the growth of C parvum sporozoites and oocysts and G 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.

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Paromomycin (Humatin)

 

Paromomycin is a poorly absorbed aminoglycoside antibiotic that has been used in patients who have AIDS and cryptosporidiosis. It has been reported to cause symptomatic improvement and possible parasite eradication in a small series of patients.

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Azithromycin (Zithromax, Zmax)

 

This agent inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

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Contributor Information and Disclosures
Author

Jaya Sureshbabu, MBBS, DCh, MRCPCH(UK), MRCPI(Paeds), MRCPS(Glasg), DCH(Glasg),  Consultant, Department of Pediatrics and Neonatology, Credence Institute for Womens Health and Fertility Research, Thiruvananthapuram

Jaya Sureshbabu, MBBS, DCh, MRCPCH(UK), MRCPI(Paeds), MRCPS(Glasg), DCH(Glasg), is a member of the following medical societies: Indian Academy of Pediatrics, Indian Medical Association, Royal College of Paediatrics and Child Health, Royal College of Physicians and Surgeons of Glasgow, and Royal College of Physicians of Ireland

Disclosure: Nothing to disclose.

Coauthor(s)

Poothirikovil Venugopalan, MBBS, MD, FRCP(Glasg), FRCPCH,  Consulting Staff, Department of Child Health, University Hospital of North Tees and Hartlepool, UK

Poothirikovil Venugopalan, MBBS, MD, FRCP(Glasg), FRCPCH, is a member of the following medical societies: British Cardiac Society, Paediatrician with Cardiology Expertise Special Interest Group, Royal College of Paediatrics and Child Health, and Royal College of Physicians and Surgeons of Glasgow

Disclosure: Nothing to disclose.

Athena P Kourtis, MD, PhD  Associate Professor, Department of Pediatrics, Divisions of Infectious Diseases and Epidemiology, Emory University School of Medicine; Senior Fellow, Centers for Disease Control and Prevention

Athena P Kourtis, MD, PhD is a member of the following medical societies: American Academy of Pediatrics and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

References

  1. Flynn PM. Cryptosporidium parvum. In: Long SS, Pickering LK, Prober CG, eds. Principles and Practice of Pediatrics. New York, NY: Churchill Livingstone; 1997.

  2. White C Jr. Cryptosporidiosis. In: Mandell GL, Bennett JE, Doilin R. Principles and practice of Infectious Diseases. Vol 2. 6th. Philadelphia, Pennsylvania: Elsivier Churchill Livingstone; 2005:280.

  3. Huang DB, Chappell C, Okhuysen PC. Cryptosporidiosis in children. Semin Pediatr Infect Dis. Oct 2004;15(4):253-9. [Medline].

  4. Committee on Infectious Diseases, American Academy of Pediatrics. Cryptosporidiosis. In: Pickering LK, Baker CJ, Long S, McMillan JA. Red book. 27th. Elk Grove Village, IL: AAP; 2006:270-272.

  5. Meinhardt PL, Casemore DP, Miller KB. Epidemiologic aspects of human cryptosporidiosis and the role of waterborne transmission. Epidemiol Rev. 1996;18(2):118-36. [Medline].

  6. Fayer R, Morgan U, Upton SJ. Epidemiology of Cryptosporidium: Transmission,detection and identification. Int J Parasitol. 2000;30:1305-1322.

  7. Cryptosporidiosis surveillance--United States, 2003-2005.Division of Parasitic Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, CDC [database online]. Atlanta, GA 30333: Centers for Disease Control and Prevention (CDC); Updated 2007 Sep 7.

  8. MacKenzie WR, Schell WL, Blair KA, Addiss DG, Peterson DE, Hoxie NJ, et al. Massive outbreak of waterborne cryptosporidium infection in Milwaukee, Wisconsin: recurrence of illness and risk of secondary transmission. Clin Infect Dis. Jul 1995;21(1):57-62. [Medline].

  9. Semenza JC, Nichols G. Cryptosporidiosis surveillance and water-borne outbreaks in Europe. Euro Surveill. May 1 2007;12(5):E13-4. [Medline].

  10. Cooper DL, Verlander NQ, Smith GE, Charlett A, Gerard E, Willocks L, et al. Can syndromic surveillance data detect local outbreaks of communicable disease? A model using a historical cryptosporidiosis outbreak. Epidemiol Infect. Feb 2006;134(1):13-20. [Medline]. [Full Text].

  11. Navin TR, Hardy AM. Cryptosporidiosis in patients with AIDS. J Infect Dis. Jan 1987;155(1):150. [Medline].

  12. Abubakar I, Aliyu SH, Arumugam C, Usman NK, Hunter PR. Treatment of cryptosporidiosis in immunocompromised individuals: systematic review and meta-analysis. Br J Clin Pharmacol. Apr 2007;63(4):387-93. [Medline]. [Full Text].

  13. Wolska-Kusnierz B, Bajer A, Caccio S, Heropolitanska-Pliszka E, Bernatowska E, Socha P, et al. Cryptosporidium infection in patients with primary immunodeficiencies. J Pediatr Gastroenterol Nutr. Oct 2007;45(4):458-64. [Medline].

  14. Cello JP. Acquired immunodeficiency syndrome cholangiopathy: spectrum of disease. Am J Med. May 1989;86(5):539-46. [Medline].

  15. Weintraub JM. Improving cryptosporidium testing methods: a public health perspective. J Water Health. 2006;4 Suppl 1:23-6. [Medline].

  16. Soave R. Treatment strategies for cryptosporidiosis. Ann N Y Acad Sci. 1990;616:442-51. [Medline].

  17. Ayuo PO. Human cryptosporidiosis: a review. East Afr Med J. Feb 2009;86(2):89-93. [Medline].

  18. Juranek DD. Cryptosporidiosis: sources of infection and guidelines for prevention. Clin Infect Dis. Aug 1995;21 Suppl 1:S57-61. [Medline].

  19. Fox LM, Saravolatz LD. Nitazoxanide: a new thiazolide antiparasitic agent. Clin Infect Dis. Apr 15 2005;40(8):1173-80. [Medline].

  20. Smith NH, Cron S, Valdez LM, Chappell CL, White AC Jr. Combination drug therapy for cryptosporidiosis in AIDS. J Infect Dis. Sep 1998;178(3):900-3. [Medline].

  21. Mofenson LM, Brady MT, Danner SP, Dominguez KL, Hazra R, Handelsman E, et al. Guidelines for the Prevention and Treatment of Opportunistic Infections among HIV-exposed and HIV-infected children: recommendations from CDC, the National Institutes of Health, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics. MMWR Recomm Rep. Sep 4 2009;58:1-166. [Medline]. [Full Text].

  22. Hicks P, Zwiener RJ, Squires J, Savell V. Azithromycin therapy for Cryptosporidium parvum infection in four children infected with human immunodeficiency virus. J Pediatr. Aug 1996;129(2):297-300. [Medline].

  23. Abubakar I, Aliyu SH, Arumugam C, Hunter PR, Usman NK. Prevention and treatment of cryptosporidiosis in immunocompromised patients. Cochrane Database Syst Rev. Jan 24 2007;CD004932. [Medline].

 
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Hematoxylin and eosin stain of intestinal epithelium. The blue dots (arrows) represent Cryptosporidium on the surface of the epithelial cells. Image courtesy of Carlos Abramowsky, MD, Professor of Pediatrics and Pathology, Emory University School of Medicine.
Cryptosporidium species oocysts are rounded and measure 4.2-5.4 µm in diameter. Sporozoites are sometimes visible inside the oocysts, indicating that sporulation has occurred on wet mount.
Cryptosporidium parvum oocysts stained with modified acid-fast. Against a blue-green background, the oocysts stand out in a bright red stain. Image courtesy of CDC DPDx parasite image library.
Cryptosporidium species oocysts stained with modified acid-fast.
 
 
 
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