Treatment

Immunocompetent patients:

• the infection is usually self limiting (though unpleasant and debilitating)
• rehydration salts if required
• advice patients regarding:
  • symptoms may continue for a longer time than other acute gastroenteritis
  • importance of strict personal hygiene to avoid person-to-person transmission
• affected children should not attend day care centers until 48 hours after diarrhoea has stopped, while food handlers and carers of highly susceptible patients also should refrain from work for the same period
• in the UK, cryptosporidiosis is notifiable only where believed to be food borne or water borne (1)

Immunocompromised patients:

• due to the severe nature of the disease and limited treatment modalities in this patients group, prevention and risk reduction are the most important interventions
• the Department of Health in England advises that patients with compromised T-cell function should boil all drinking water (including bottled water) to reduce the risk of infection
• aim of treatment is to reduce symptoms of diarrhoea and prevent dehydration
• immune reconstitution has led to improvement of the infection
  • in HIV patients, highly active antiretroviral therapy (HAART) is the treatment of choice
  • parasite clearance and resolution of sclerosing cholangitis was reported in a renal transplant patient who had an accidental reduction in immunosuppression (1)

Specific therapy:

• Nitazoxanide
  • approved by the United States Food and Drug Administration
  • used in immunocompetent patients older than 1 year
  • not licensed in the UK (but available on a named patient basis)
  • several studies have reported the benefits of nitazoxanide in immunocompetent patients (benefits in immunosuppressed patients is not conclusive)
  • is well tolerated with a good safety profile.
• drugs currently available in the UK have not proven to be beneficial and are unlicensed for cryptosporidiosis
  • drugs used to treat Cryptosporidium infection include (all with anti-parasitic activity):
    • aminoglycoside – paromomycin
    • macrolides - spiramycin, azithromycin, and clarithromycin (1)

Reference:

• (1) Davies AP, Chalmers RM. Cryptosporidiosis. BMJ. 2009;339:b4168.