eMedicine Specialties > Pediatrics: General Medicine > Parasitology

Cyclosporiasis: Treatment & Medication

Author: Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Coauthor(s): Cathy Jo Schroeder, RN, MSN, APN-C, Family Nurse Practitioner for James A Boozan MD, Otolaryngologist
Contributor Information and Disclosures

Updated: Jan 21, 2009

Treatment

Medical Care

Cyclosporiasis appears to be self-limited in an immunocompetent host, lasting several days to 2 weeks. The only supportive care typically needed is the replenishment of fluids and electrolytes with juices, water, and caffeine-free soda. Occasionally, the infection can persist for 3-5 weeks, necessitating oral rehydration therapy, parenteral rehydration therapy, or both. Infection in an immunocompromised host or in a child may require parenteral rehydration.

Consultations

For prolonged or severe cases, consultation with infectious diseases specialists, gastroenterologists, or both may help.

Diet

Typical dietary measures for gastroenteritis are appropriate.

Medication

Trimethoprim-sulfamethoxazole (TMP-SMZ) has proven effective in managing cyclosporiasis in immunocompetent and immunocompromised hosts.12 TMP-SMZ administration can reduce shedding of oocysts to 1.3 days (from 9 d) and stops diarrhea within 2 days.

An immunocompromised host requires oral antibiotic therapy for longer periods, followed by prophylaxis to prevent recurrence. One study has indicated that if the patient is allergic to or does not tolerate sulfa-containing medications, ciprofloxacin is an alternative treatment. Treatment with pyrimethamine and nitazoxanide is also being studied.

Antibiotics

These agents are used to treat infection. The combination product containing TMP-SMZ is considered the DOC for managing cyclosporiasis.


Trimethoprim and sulfamethoxazole (Bactrim, Septra, Cotrim)

The only antibiotic that has been shown effective for treating cyclosporiasis. Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid.

Adult

Immunocompetent host: 160 mg TMP/800 mg SMZ PO bid for 7 d
Immunocompromised host: 160 mg TMP/800 mg SMZ PO qid for 10 d, followed by prophylaxis with 160 mg TMP/800 mg SMZ 3 times/wk

Pediatric

8 mg/kg/d (based on TMP component) PO divided bid for 7 d

May increase PT when used with warfarin (perform coagulation tests and adjust dose accordingly); coadministration with dapsone may increase blood levels of both drugs; coadministration of diuretics increases prevalence of thrombocytopenia purpura in elderly; phenytoin levels may increase with coadministration; may potentiate effects of methotrexate in bone marrow depression; hypoglycemic response to sulfonylureas may increase with coadministration; may increase zidovudine levels

Documented hypersensitivity; megaloblastic anemia due to folate deficiency

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Do not use near term in pregnancy because of risk of kernicterus in newborn; discontinue at first appearance of rash or sign of adverse reaction; frequently obtain CBC counts; discontinue therapy if significant hematologic changes occur; goiter, diuresis, and hypoglycemia may occur with sulfonamides; caution in folate deficiency (eg, patients with chronic alcoholism, elderly persons, patients receiving anticonvulsant therapy, or those with malabsorption syndrome); hemolysis may occur in individuals with G-6-PD deficiency; patients with AIDS may not tolerate or respond to TMP-SMZ; caution in renal or hepatic impairment (perform urinalyses and renal function tests during therapy); administer fluids to prevent crystalluria and stone formation

More on Cyclosporiasis

Overview: Cyclosporiasis
Differential Diagnoses & Workup: Cyclosporiasis
Treatment & Medication: Cyclosporiasis
Follow-up: Cyclosporiasis
References
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Further Reading

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Keywords

cyclosporiasis, acquired immunodeficiency syndrome, AIDS, biliary disease, blue-green algae, chronic diarrhea, coccidian-like body, Cyanobacterium infection, Cyclospora cayetanensis, C cayetanensis, diarrhea, gastroenteritis, GI infection, large Cryptosporidium infection, parasite, parasitic infection

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Contributor Information and Disclosures

Author

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Coauthor(s)

Cathy Jo Schroeder, RN, MSN, APN-C, Family Nurse Practitioner for James A Boozan MD, Otolaryngologist
Cathy Jo Schroeder, RN, MSN, APN-C is a member of the following medical societies: American Academy of Nurse Practitioners and Sigma Theta Tau International
Disclosure: Nothing to disclose.

Medical Editor

Michael D Nissen, MBBS, BMedSc, FRACP, FRCPA, Associate Professor in Biomolecular, Biomedical Science & Health, Griffith University; Director of Infectious Diseases and Unit Head of Queensland Paediatric Infectious Laboratory, Sir Albert Sakzewski Viral Research Centre, Royal Children's Hospital
Michael D Nissen, MBBS, BMedSc, FRACP, FRCPA is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Pediatric Infectious Diseases Society, Royal Australasian College of Physicians, and Royal College of Pathologists of Australasia
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Martin Weisse, MD, Program Director, Associate Professor, Department of Pediatrics, West Virginia University
Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting; Pfizer Honoraria Consulting

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: None None None

 
 
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