Diarrhea, Cryptosporidiosis, Nitazoxanide, Paromomycin and Azithromycin
Treatment Outcomes with Nitazoxanide in Immunocompetent Adults Naïve Patients with Cryptosporidiosis; Do We Need Combination Therapy with Paromomycin or Azithromycin?
Sajjad Ali, Sunil Kumar, Kiran Kalam, Asma Nasim, Shehla Baqi
Department of Infectious Diseases, Sindh Institute of Urology and Transplantation
Human cryptosporidiosis is caused by infection with Cryptosporidium. Nitazoxanide has shown activity against cryptosporidium. The objective of this study is to see treatment outcomes with 7 days of nitazoxanide in immunocompetent adult patients diagnosed with cryptosporidiosis and to consider combination therapy which includes nitazoxanide with paromomycin or azithromycin?
This cross sectional study was conducted at Sindh Institute of Urology and Transplantation, Karachi Pakistan. Patients were not enrolled with prior diagnosis of cryptosporidiosis and/or had taken Nitazoxanide, Paromomycin or Azithromycin in last 4 weeks prior their diagnosis. Also patients were excluded if they were diagnosed as case of HIV/AIDS, history of solid organ transplantation, any malignancy or were taking steroids and immunosuppressant drugs.
A total of 58 patients who had cryptosporidiosis were included in this study. 31 (53.4%) were males and 27 (46.6%) females. The mean age was 33.4 years with standard deviation ± 9.2. No statistical significance was seen in clinical presentation of cryptosporidiosis in both male and female genders. All 58 (100%) reported resolution of diarrhea after 7 days of nitazoxanide treatment. However, at 6 weeks follow up, 40 (70.1%) patients had recurrence of diarrhea where as only 17 (29.9%) had no further episode of diarrhea.
Nitazoxanide is a new nitrothiazole compound with broadspectrum activity against numerous intestinal protozoa and helminths and have very good bio-safety profile. All 58 patients after 7 days of treatment with nitazoxanide showed good clinical response after short term. But in long term patients reported a high recurrence in 6 weeks period time. There is need of combination therapy which includes nitazoxanide with paromomycin or azithromycin in high recurrence/relapse patients.
Treatment Outcomes with Nitazoxanide in Immunocompetent Adults Naïve Patients with Cryptosporidiosis; Do We Need Combination Therapy with Paromomycin or Azithromycin?International Journal of Infectious & Emerging Diseases , 1:1 (17 November 2014)
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