Cyclospora Infection (Cyclosporiasis) Medication

Updated: Aug 08, 2017
  • Author: William H Shoff, MD, DTM&H; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Medication

Medication Summary

TMP-SMZ is the drug of choice. Immunocompetent patients become symptom-free within a median of 3 days. In a study of Haitian patients with AIDS, individuals cleared the organism on average 2.5 days into treatment during a 10-day regimen.

One small study of 20 patients with HIV compared TMP-SMZ (n = 9) with ciprofloxacin (n = 11) in the treatment of C cayetanensis infection. [20] With TMP-SMZ by day 7, diarrhea had ceased in 9 of 9 patients, and stools were negative for oocysts in all 9 patients. With ciprofloxacin by day 7, diarrhea ceased in 10 of 11 patients, and stools were negative for oocysts in 7 of 11 patients (64%). The conclusion was that, although ciprofloxacin is not as effective as TMP-SMZ, it is an acceptable alternative for patients unable to tolerate TMP-SMZ. However, this study has not been replicated, and other studies have commented that ciprofloxacin treatment did not produce a good response. The consensus among many practitioners is that ciprofloxacin is not a satisfactory treatment for cyclosporiasis, and they do not use it if the patient is allergic to sulfa.

Results from small studies have not demonstrated norfloxacin, metronidazole, tinidazole, quinacrine, and azithromycin to be effective.

Nitazoxanide, a 5-nitrothiazole derivative with broad-spectrum activity against helminths and protozoans, has been shown to be effective against C cayetanensis, with an efficacy 87% by the third dose (first, 71%; second 75%). Three percent of patients had minor side effects.

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Antibiotics

Class Summary

Therapy must be comprehensive, covering all likely pathogens in the context of this clinical setting.

Trimethoprim-sulfamethoxazole (Bactrim, Bactrim DS, Septra, Septra DS)

Combination antibiotic inhibits 2 sequential steps in bacterial folate synthesis. It has a wide spectrum of activity and reduced resistance because of the combined action of 2 drugs. Most gram-positive and gram-negative organisms are sensitive. Typically resistant organisms include Pseudomonas aeruginosa, Bacteroides fragilis, and enterococci. After oral administration, TMP peaks by 2 h and SMZ by 4 h. Respective half-lives are 11 h and 10 h.

Ciprofloxacin (Cipro)

Fluorinated 4-quinolone. Broad-spectrum antimicrobial inhibits gyrase-mediated DNA supercoiling in bacteria, leading to disruption of bacterial DNA replication. Effective against many gram-positive and gram-negative organisms. Inhibits several intracellular bacteria (ie, Chlamydia, Mycoplasma, Legionella, Brucella, Mycobacterium). In one study, 1 of 7 patients administered 500 mg 3 times qwk had a recurrence after 4 wk of therapy (no recurrences with TMP-SMZ). Well-absorbed after PO administration, peaks within 1-3 h, and serum elimination half-life is 5-6 h.

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