What is the treatment for Cryptosporidiosis (Cryptosporidium infection)?

From the Guidelines

Cryptosporidium infection is primarily treated with supportive care, and for those with compromised immune systems, nitazoxanide is the only FDA-approved medication, typically prescribed as 100 mg orally twice daily for children aged 1-3 years and 200 mg twice daily for children aged 4-11 years. The most important treatment is maintaining hydration through oral rehydration solutions or, in severe cases, intravenous fluids.

Treatment Options

• Nitazoxanide has demonstrated efficacy in decreasing the severity of symptoms among children, with a clinical response of 88% with nitazoxanide and 38% with placebo in an Egyptian clinical trial 1.
• Alternative treatments sometimes used in severe cases include paromomycin (25-35 mg/kg/day in three divided doses) or azithromycin (600 mg daily), though these are less established 1.
• In immunocompromised patients, particularly those with HIV/AIDS, improving immune function through antiretroviral therapy is crucial for controlling the infection.

Key Considerations

• Prevention of dehydration is essential during treatment, as cryptosporidiosis causes significant fluid loss.
• The parasite is resistant to chlorine disinfection and has a protective outer shell, making it difficult to treat, which explains why supportive care and targeted antiparasitic therapy are the mainstays of management.
• Azithromycin has demonstrated some activity against C. parvum infection in a limited number of HIV-infected children, with a regimen of 10 mg/kg per day on day 1 and 5 mg/kg per day on days 2-10 being successful in rapidly resolving enteric symptoms 1.

From the FDA Drug Label

ALINIA is an antiprotozoal indicated for the treatment of diarrhea caused by Giardia lamblia or Cryptosporidium parvum(1). Limitations of Use: ALINIA has not been shown to be effective for the treatment of diarrhea caused by C. parvum in HIV-infected or immunodeficient patients (1) Diarrhea caused by Giardia lamblia or Cryptosporidium parvum: ALINIA for Oral Suspension (patients 1 year of age and older) and ALINIA Tablets (patients 12 years and older) are indicated for the treatment of diarrhea caused by Giardia lamblia or Cryptosporidium parvum.

Treatment for Cryptosporidium: Nitazoxanide (PO) is indicated for the treatment of diarrhea caused by Cryptosporidium parvum in patients 1 year of age and older. However, it has not been shown to be effective in HIV-infected or immunodeficient patients 2, 2, 2.

• Dosage: The dosage for treatment of diarrhea caused by C. parvum is as follows:
  • 1-3 years: 5 mL of ALINIA for Oral Suspension (100 mg nitazoxanide) every 12 hours with food for 3 days
  • 4-11 years: 10 mL of ALINIA for Oral Suspension (200 mg nitazoxanide) every 12 hours with food for 3 days
  • 12 years and older: One ALINIA Tablet (500 mg nitazoxanide) every 12 hours with food or 25 mL of ALINIA for Oral Suspension (500 mg nitazoxanide) every 12 hours with food for 3 days
• Limitations: ALINIA has not been shown to be effective for the treatment of diarrhea caused by C. parvum in HIV-infected or immunodeficient patients.

From the Research

Treatment Options for Cryptosporidiosis

• Nitazoxanide is a commonly used treatment for cryptosporidiosis, with studies showing its efficacy in immunocompetent and immunocompromised patients 3, 4.
• The treatment has been shown to be effective in reducing the incidence of cryptosporidiosis in HIV-infected patients on highly active antiretroviral therapy 3.
• However, recent studies have highlighted the need for more efficacious therapies, particularly in high-risk populations such as HIV and transplant patients, and malnourished children 5.
• Other treatment options, such as paromomycin, have been studied, but nitazoxanide has been shown to be more effective in some cases 6.

Efficacy of Nitazoxanide

• Nitazoxanide has been shown to have clinical and parasitologic response rates close to 80% and 70%, respectively, in immunocompetent patients 4.
• Response rates have been lower in immunocompromised patients, highlighting the need for alternative treatment options 4.
• A comparative study between nitazoxanide and paromomycin found that nitazoxanide was more effective in treating cryptosporidiosis in hospitalized children 6.

Limitations of Current Treatments

• Current approved therapies for cryptosporidiosis are far from optimal and lack efficacy in high-risk populations 5.
• There is limited data on patients with other types of immunosuppression, such as transplant recipients and those with autoimmune conditions 5.
• The development of new and more efficacious therapies for cryptosporidiosis is imperative, particularly in high-risk populations 5.