Cryptosporidiosis medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
Medical management of Cryptosporidium infection includes supportive care, symptomatic management and prompt initiation of antiretroviral therapy. | Medical management of [[Cryptosporidium]] infection includes supportive care, symptomatic management and prompt initiation of [[HIV AIDS medical therapy|antiretroviral therapy]]. | ||
{{Cryptosporidiosis}} | {{Cryptosporidiosis}} | ||
==Medical Therapy== | ==Medical Therapy== | ||
Medical management of Cryptosporidium infection includes supportive care, symptomatic management and prompt initiation of antiretroviral therapy. The principles of therapy include the following:<br> | Medical management of [[Cryptosporidium]] infection includes supportive care, symptomatic management and prompt initiation of [[HIV AIDS medical therapy|antiretroviral therapy]]. The principles of therapy include the following:<br> | ||
'''Preferred Management Strategies''': | '''Preferred Management Strategies''':<ref>{{cite web |url=https://www.idsociety.org/uploadedFiles/HIVMA/Guidelines_Patient_Care/HIVMA_Standards_Practice_Guidelines/HIV_Guidelines/Guidelines_Content/adult_oi.pdf |title=www.idsociety.org |format= |work= |accessdate=}}</ref> | ||
*Initiate or optimize ART for immune restoration to CD4 count >100 cells/mm3 {{or}} | *Initiate or optimize [[HIV AIDS medical therapy|ART]] for immune restoration to [[CD4]] count >100 cells/mm3 {{or}} | ||
*Aggressive oral and/or IV rehydration and replacement of electrolyte loss {{or}} | *Aggressive oral and/or [[Intravenous therapy|IV]] [[rehydration]] and replacement of [[Electrolyte imbalance|electrolyte]] loss {{or}} | ||
*Symptomatic treatment of diarrhea with anti-motility agent {{or}} | *Symptomatic treatment of [[diarrhea]] with anti-motility agent {{or}} | ||
*Tincture of opium may be more effective than loperamide | *Tincture of [[opium]] may be more effective than [[loperamide]] | ||
'''Alternative Management Strategies''':<br> | '''Alternative Management Strategies''':<br> | ||
*Nitazoxanide 500–1000 mg PO BID with food for 14 days '''+''' optimized ART, symptomatic treatment, and rehydration and electrolyte replacement, {{or}} | *[[Nitazoxanide]] 500–1000 mg PO BID with food for 14 days '''+''' optimized [[HIV AIDS medical therapy|ART]], symptomatic treatment, and [[rehydration]] and electrolyte replacement, {{or}} | ||
*Paromomycin 500 mg PO QID for 14 to 21 days '''+''' optimized ART, symptomatic treatment and rehydration and electrolyte replacement | *[[Paromomycin]] 500 mg PO QID for 14 to 21 days '''+''' optimized [[HIV AIDS medical therapy|ART]], symptomatic treatment and rehydration and electrolyte replacement | ||
===Supportive care=== | ===Supportive care=== | ||
* Supportive management of [[diarrhea]] should be by advising patients to drink plenty of fluids to prevent dehydration. People who are in poor health or who have weakened [[immune system]]s are at higher risk for more severe and prolonged illness. Young children and [[pregnant]] women may be more susceptible to dehydration resulting from diarrhea and should drink plenty of fluids while ill. Rapid loss of fluids from diarrhea may be especially life threatening to babies. Therefore, parents should talk to their health care providers about fluid replacement therapy options for infants. | * Supportive management of [[diarrhea]] should be by advising patients to drink plenty of fluids to prevent [[dehydration]]. People who are in poor health or who have weakened [[immune system]]s are at higher risk for more severe and prolonged illness. Young children and [[pregnant]] women may be more susceptible to [[dehydration]] resulting from [[diarrhea]] and should drink plenty of fluids while ill. Rapid loss of fluids from [[diarrhea]] may be especially life threatening to babies. Therefore, parents should talk to their health care providers about fluid replacement therapy options for [[infants]]. | ||
*Symptomatic therapy with anti-motility agents and a tincture of opium are preferred over loperamide. | *Symptomatic therapy with anti-motility agents and a tincture of opium are preferred over loperamide. | ||
* [[Nitazoxanide]] has been FDA-approved for treatment of diarrhea caused by [[Cryptosporidium]] in people with healthy immune systems and is available by prescription. However, the effectiveness of nitazoxanide in [[immunosuppressed]] individuals is unclear. | * [[Nitazoxanide]] has been FDA-approved for treatment of diarrhea caused by [[Cryptosporidium]] in people with healthy immune systems and is available by prescription. However, the effectiveness of [[nitazoxanide]] in [[immunosuppressed]] individuals is unclear. | ||
* [[HIV-positive]] individuals who suspect they have cryptosporidiosis should contact their health care provider. For those persons with [[AIDS]], anti retroviral therapy that improves the immune status will also decrease or eliminate symptoms of cryptosporidiosis. However, even if symptoms disappear, cryptosporidiosis is often not curable and the symptoms may return if the immune status worsens. | * [[HIV-positive]] individuals who suspect they have [[cryptosporidiosis]] should contact their health care provider. For those persons with [[AIDS]], [[HIV AIDS medical therapy|anti retroviral therapy]] that improves the immune status will also decrease or eliminate symptoms of [[cryptosporidiosis]]. However, even if symptoms disappear, [[cryptosporidiosis]] is often not curable and the symptoms may return if the immune status worsens. | ||
===Treatment Regimen=== | ===Treatment Regimen=== | ||
* ''' Immunocompetent patients'''<ref name="pmid11398117">{{cite journal| author=Rossignol JF, Ayoub A, Ayers MS| title=Treatment of diarrhea caused by Cryptosporidium parvum: a prospective randomized, double-blind, placebo-controlled study of Nitazoxanide. | journal=J Infect Dis | year= 2001 | volume= 184 | issue= 1 | pages= 103-6 | pmid=11398117 | doi=10.1086/321008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11398117 }} </ref> | * ''' Immunocompetent patients'''<ref name="pmid11398117">{{cite journal| author=Rossignol JF, Ayoub A, Ayers MS| title=Treatment of diarrhea caused by Cryptosporidium parvum: a prospective randomized, double-blind, placebo-controlled study of Nitazoxanide. | journal=J Infect Dis | year= 2001 | volume= 184 | issue= 1 | pages= 103-6 | pmid=11398117 | doi=10.1086/321008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11398117 }} </ref> | ||
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:* Preferred regimen: [[Nitazoxanide]] 500 mg PO bid for 3 days | :* Preferred regimen: [[Nitazoxanide]] 500 mg PO bid for 3 days | ||
* '''HIV infection and with severe immunosuppression'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref> | * '''HIV infection and with severe immunosuppression'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref> | ||
:* No pharmacologic or immunologic therapy directed against Cryptosporidium has been shown to be consistently effective when used without antiretroviral therapy. | :* No pharmacologic or immunologic therapy directed against [[Cryptosporidium]] has been shown to be consistently effective when used without [[HIV AIDS medical therapy|antiretroviral therapy.]] | ||
:* In patients with severe immunosuppression antiretroviral therapy must be initiated immediately and the goal for CD4 cells should be greater than 100cells/mm³. This alone will result in the resolution of the clinical symptoms. | :* In patients with severe [[immunosuppression]] antiretroviral therapy must be initiated immediately and the goal for [[CD4]] cells should be targeted for a value greater than 100cells/mm³. This alone will result in the resolution of the clinical symptoms. | ||
:* Note: Nitazoxanide is not licensed for immunodeficient patients. | :* Note: [[Nitazoxanide]] is not licensed for [[Immunodeficiency|immunodeficient]] patients. | ||
:* All the patients must be monitored closely for signs and symptoms of volume depletion, electrolyte imbalance, weight loss, and malnutrition. | :* All the patients must be monitored closely for signs and symptoms of [[volume depletion]], [[electrolyte imbalance]], [[weight loss]], and [[malnutrition]]. | ||
:*Total parenteral nutrition or repletion of electrolytes by intravenous route may be indicated in patients certain patients with severe diarrhea can exceeding >10 L/day. | :*[[Total parenteral nutrition]] or repletion of electrolytes by [[Intravenous therapy|intravenous route]] may be indicated in patients certain patients with severe [[diarrhea]] can exceeding >10 L/day. | ||
===Failure to Therapy=== | ====Failure to Therapy==== | ||
*Supportive treatment and optimization of ART to achieve full virologic suppression are the only feasible approaches to managing treatment failure. | *Supportive treatment and optimization of [[HIV AIDS medical therapy|ART]] to achieve full virologic suppression are the only feasible approaches to managing treatment failure. | ||
===Pregnancy=== | |||
*Rehydration and initiation of ART are the mainstays of initial treatment of cryptosporidiosis during pregnancy, as they are in non-pregnant women. | ====Pregnancy==== | ||
*Nitazoxanide can be used in pregnancy after the first trimester in women with severe symptoms. | *[[Rehydration]] and initiation of [[HIV AIDS medical therapy|ART]] are the mainstays of initial treatment of [[cryptosporidiosis]] during [[pregnancy]], as they are in non-pregnant women. | ||
*Loperamide should be avoided in the first trimester, unless benefits are felt to outweigh potential risks. | *[[Nitazoxanide]] can be used in [[pregnancy]] after the [[first trimester]] in women with severe symptoms. | ||
*Opiate exposure is associated with neonatal respiratory depression, and chronic exposure may result in neonatal withdrawal, therefore not indicated for symptomatic treatment. | *[[Loperamide]] should be avoided in the [[first trimester]], unless benefits are felt to outweigh potential risks. | ||
*[[Opiate]] exposure is associated with neonatal [[respiratory depression]], and chronic exposure may result in neonatal [[Opiate withdrawal|withdrawal]], therefore not indicated for symptomatic treatment. | |||
==External Link== | ==External Link== | ||
http://www.cdc.gov/parasites/crypto/treatment.html | http://www.cdc.gov/parasites/crypto/treatment.html | ||
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[[Category:Needs overview]] | [[Category:Needs overview]] | ||
[[Category:Parasitic diseases]] | [[Category:Parasitic diseases]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
Latest revision as of 17:31, 18 September 2017
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2]
Overview
Medical management of Cryptosporidium infection includes supportive care, symptomatic management and prompt initiation of antiretroviral therapy.
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Cryptosporidiosis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Cryptosporidiosis medical therapy On the Web |
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American Roentgen Ray Society Images of Cryptosporidiosis medical therapy |
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Risk calculators and risk factors for Cryptosporidiosis medical therapy |
Medical Therapy
Medical management of Cryptosporidium infection includes supportive care, symptomatic management and prompt initiation of antiretroviral therapy. The principles of therapy include the following:
Preferred Management Strategies:[1]
- Initiate or optimize ART for immune restoration to CD4 count >100 cells/mm3 OR
- Aggressive oral and/or IV rehydration and replacement of electrolyte loss OR
- Symptomatic treatment of diarrhea with anti-motility agent OR
- Tincture of opium may be more effective than loperamide
Alternative Management Strategies:
- Nitazoxanide 500–1000 mg PO BID with food for 14 days + optimized ART, symptomatic treatment, and rehydration and electrolyte replacement, OR
- Paromomycin 500 mg PO QID for 14 to 21 days + optimized ART, symptomatic treatment and rehydration and electrolyte replacement
Supportive care
- Supportive management of diarrhea should be by advising patients to drink plenty of fluids to prevent dehydration. People who are in poor health or who have weakened immune systems are at higher risk for more severe and prolonged illness. Young children and pregnant women may be more susceptible to dehydration resulting from diarrhea and should drink plenty of fluids while ill. Rapid loss of fluids from diarrhea may be especially life threatening to babies. Therefore, parents should talk to their health care providers about fluid replacement therapy options for infants.
- Symptomatic therapy with anti-motility agents and a tincture of opium are preferred over loperamide.
- Nitazoxanide has been FDA-approved for treatment of diarrhea caused by Cryptosporidium in people with healthy immune systems and is available by prescription. However, the effectiveness of nitazoxanide in immunosuppressed individuals is unclear.
- HIV-positive individuals who suspect they have cryptosporidiosis should contact their health care provider. For those persons with AIDS, anti retroviral therapy that improves the immune status will also decrease or eliminate symptoms of cryptosporidiosis. However, even if symptoms disappear, cryptosporidiosis is often not curable and the symptoms may return if the immune status worsens.
Treatment Regimen
- Immunocompetent patients[2]
- Preferred regimen: No specific therapy recommended since healthy patients usually recover within a few weeks, but if needed: Nitazoxanide 500 mg PO bid for 3 days.
- HIV positive patients[3]
- Preferred regimen: Nitazoxanide 500 mg PO bid for 3 days
- HIV infection and with severe immunosuppression[4]
- No pharmacologic or immunologic therapy directed against Cryptosporidium has been shown to be consistently effective when used without antiretroviral therapy.
- In patients with severe immunosuppression antiretroviral therapy must be initiated immediately and the goal for CD4 cells should be targeted for a value greater than 100cells/mm³. This alone will result in the resolution of the clinical symptoms.
- Note: Nitazoxanide is not licensed for immunodeficient patients.
- All the patients must be monitored closely for signs and symptoms of volume depletion, electrolyte imbalance, weight loss, and malnutrition.
- Total parenteral nutrition or repletion of electrolytes by intravenous route may be indicated in patients certain patients with severe diarrhea can exceeding >10 L/day.
Failure to Therapy
- Supportive treatment and optimization of ART to achieve full virologic suppression are the only feasible approaches to managing treatment failure.
Pregnancy
- Rehydration and initiation of ART are the mainstays of initial treatment of cryptosporidiosis during pregnancy, as they are in non-pregnant women.
- Nitazoxanide can be used in pregnancy after the first trimester in women with severe symptoms.
- Loperamide should be avoided in the first trimester, unless benefits are felt to outweigh potential risks.
- Opiate exposure is associated with neonatal respiratory depression, and chronic exposure may result in neonatal withdrawal, therefore not indicated for symptomatic treatment.
External Link
http://www.cdc.gov/parasites/crypto/treatment.html
References
- ↑ "www.idsociety.org" (PDF).
- ↑ Rossignol JF, Ayoub A, Ayers MS (2001). "Treatment of diarrhea caused by Cryptosporidium parvum: a prospective randomized, double-blind, placebo-controlled study of Nitazoxanide". J Infect Dis. 184 (1): 103–6. doi:10.1086/321008. PMID 11398117.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.