Cyclospora Infection (Cyclosporiasis) Medication

Updated: Jul 16, 2021
  • Author: Chinelo N Animalu, MD, MPH; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Medication

Medication Summary

Trimethoprim/sulfamethoxazole (TMP-SMZ) is the drug of choice for treating cyclosporiasis. A standard dose of TMP 160 mg plus SMX 800 mg (one double-strength tablet), orally, twice daily should be used. Immunocompetent patients become symptom-free within a median of 3 days. In a study of patients with AIDS in Haiti, individuals cleared the organism on average 2.5 days into treatment during a 10-day regimen. In patients with immunosuppression, a higher dose of TMP-SMZ as well as extending treatment duration to about 14 days may be necessary. [7]

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. Thus, nitazoxanide could be a useful alternative to patients allergic to TMP-SMZ.  [17]

One small study of 20 patients with HIV compared TMP-SMZ (n = 9) with ciprofloxacin (n = 11) in the treatment of C cayetanensis infection. [38] 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 may not be a satisfactory treatment for cyclosporiasis.

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

 

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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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