In a trial of the use of miltefosine to treat HIV‐related cryptosporidiosis in Zambian adults, extreme metabolic disturbances contribute to high mortality

Introducing Miltefosine as an Anti-cryptosporidial Agent in Immunocompromised Mice

“…Twenty days after treatment with miltefosine did not ameliorate undesired result appeared in intestinal morphology with group (IIb), although a decrease in oocysts output percentage has been noticed. This finding is in agreement with [23] who reported that 6 of (41) HIV patient with cryptosporidiosis developed colonic infarction with intestinal obstruction on 6 day post treatment with miltefosine. Similarly pharmacokinetics studies have shown that oral administration of miltefosine has many adverse effects such as gastrointestinal symptoms and the severity may due to the immune state of mice [4].…”

“…On the other hand, administration of miltefosine for Twenty days revealed significant reduction (p<0.001) in the number of oocysts in infected treated groups the reduction being (38.63%) respectively. These results are in accordance with the study of Sinkala et al [23] reported that miltefosine administration to Zambian adults with HIVrelated cryptosporidiosis was terminated prematurely because of lack of efficacy and the development of severe adverse events. In another study the activity of miltefosine against C. parvum was demonstrated in vitro showing 78-98% inhibition of parasite at 45h post infection [24].…”

Therapeutic effects of acetylspiramycin and garlicin on cryptosporidiosis among drug users

“…Although there are a large number of antiparasitic antibiotics clinically available, only few are practically used to treat cryptosporidiosis, including specifically paromomycin, azithromycin, spiramycin ( Graczyk et al., 2011 , Sinkala et al., 2011 , Das et al., 2013 ) and nitazoxanide ( Mainali et al., 2013 ). However, their therapeutic effects are limited ( Graczyk et al., 2011 , Sinkala et al., 2011 ; Mainali et al., 2013 ; Das et al., 2013 , Yacoub et al., 2014 ). There are a few studies on the anti- Cryptosporidium activities of garlicin in China ( Han, 1989 , Ge et al., 2001 , Chen and Shen, 2011 ).…”

“…However, there's no reliable treatment for cryptosporidiosis ( Vandenberg et al., 2012 ). The most commonly-used antiparasitic antibiotics such as paromomycin, azithromycin, and spiramycin are only partially effective ( Graczyk et al., 2011 , Sinkala et al., 2011 , Das et al., 2013 ). Nitazoxanide, a relatively new antiparasitic drug, has been approved for treatment of diarrhea caused by Cryptosporidium in people with healthy immune systems, but is ineffective in immunosuppressed individuals ( Mainali et al., 2013 , Yacoub et al., 2014 ).…”

An Overview of Mucosa-Associated Protozoa: Challenges in Chemotherapy and Future Perspectives

“…Some of them (paromomycin, clarithromycin, azithromycin, rifaximin, rifabutin, and roxithromycin) ( Shrivastava et al., 2017 ) have demonstrated limited potential when used in animal models, and all were ineffective in controlled trials in AIDS patients. Also, preclinical activity with miltefosine (originally developed as an anticancer drug) and clofazimine (leprosy drug) has been demonstrated, which had no efficacy in phase II studies in AIDS patients ( Gavrilov, 1989 ; Croft et al., 2003 ; Sinkala et al., 2011 ; Huston, 2021 ).…”