AIDS-related cryptosporidial diarrhoea: an open study with roxithromycin

Abstract

In immunocompromised patients, cryptosporidial diarrhoea is a debilitating and potentially life-threatening infection for which no effective specific therapy exists. In an uncontrolled study of 24 AIDS patients with diarrhoea exclusively due to Cryptosporidium spp., treatment with roxithromycin, 300 mg bd for 4 weeks, produced symptomatic improvement of diarrhoea in 79% of cases, with 50% of patients achieving complete response. The response rate was 100% in a subgroup of five patients with no previous or concomitant opportunistic infections. In complete responders, improvement was rapid, occurring within 3-5 days, and the duration of response was at least 6 months. Response did not appear to be correlated with the degree of immunodeficiency. The most limiting adverse effects were abdominal pain (two patients), elevated hepatic enzymes (two patients) and abdominal pain with elevated hepatic enzymes (one patient). Minor symptoms, such as gastrointestinal upset, occurred in nine patients. We conclude that roxithromycin is relatively well tolerated and effective against cryptosporidial diarrhoea in AIDS patients. Further studies to optimize dosing regimens are required.

Treatment of cryptosporidiosis in immunocompromised individuals: systematic review and meta‐analysis

“…Twenty‐one papers in full text were considered for inclusion into the review. Fourteen papers were excluded due to the nonrandomized nature of the study [11–18], the use of healthy, immunocompetent adults or children [19–22], single patient trial [23] or the lack of adequate placebo or comparator [24]. Seven randomized, double‐blind trials involving 169 participants were included.…”

Treatment of Cryptosporidiosis

“…In a contrasting study, rifabutin, but not clarithromycin, decreased the risk of developing cryptosporidiosis in HIV-infected patients (Fichtenbaum et al 2000). Therapeutic efficacy was reported with clarithromycin (Fujikawa et al 2002) and with roxithromycin (Uip et al 1998;Sprinz et al 1998). Symptomatic improvement and resolution of oocyst shedding in an AIDS patient followed a 3 week course of clarithromycin (800 mg/day), although CD4 + counts concomitantly rose from 152 to 180/μL perhaps indicating immune responsiveness played an important role (Fujikawa et al 2002).…”

“…In another uncontrolled study of 24 AIDS patients with cryptosporidiosis, treatment with roxithromycin (300 mg b.i.d.) for 4 weeks produced symptomatic improvement of diarrhea in 79 % of cases, with 50 % of patients achieving complete response (Sprinz et al 1998). …”

The patient with refractory diarrhoea

“…41 Alternative, but less effective options include spiramycin, azithromycin and albendazole. [43][44][45][46][47][48][49][50] Like isospora, cyclospora is also responsive to TMP-SMX (160 mg/800 mg twice daily for 7 days). 51 This results in the eradication of the infection in more than 90% of individuals; continuation of treatment for a further three days will cure the majority of remaining patients.…”