From the Guidelines
No, Azithromycin does not reliably cover Cryptosporidiosis and Giardiasis.
Rationale
- The evidence suggests that Azithromycin has some activity against C. parvum infection, which causes Cryptosporidiosis, but this is based on a limited number of HIV-infected children 1.
- A specific Azithromycin regimen of 10 mg/kg per day on day 1 and 5 mg/kg per day on days 2--10 was successful in resolving enteric symptoms in three of four HIV-infected children with cryptosporidiosis, but this is not a strong enough evidence to support its use as a reliable treatment for Cryptosporidiosis and Giardiasis in general.
- There is no mention of Azithromycin's effectiveness against Giardiasis in the provided evidence.
- The overall quality of evidence is low (CIII), which means that the recommendation is based on expert opinion rather than strong scientific evidence.
From the Research
Effectiveness of Azithromycin against Cryptosporidiosis
- Azithromycin has been shown to be effective in treating cryptosporidiosis in both immunocompetent and immunocompromised patients 2, 3, 4, 5.
- Studies have demonstrated that azithromycin can lead to significant clinical improvement and parasitological clearance in patients with cryptosporidiosis 2, 3, 4, 5.
- Long-term, low-dose azithromycin treatment has been associated with stable remission and possible eradication of chronic cryptosporidiosis in patients with AIDS 5.
Effectiveness of Azithromycin against Giardiasis
- There is no direct evidence from the provided studies to suggest that azithromycin is effective against giardiasis.
- However, other treatments such as nitazoxanide, albendazole, and nitroimidazoles (e.g. metronidazole or tinidazole) have been shown to be effective against giardiasis 6.
Comparison of Azithromycin with Other Treatments
- Azithromycin has been compared to other treatments such as paromomycin and praziquantel, and has been shown to be effective in treating cryptosporidiosis 2, 3.
- Nitazoxanide has been licensed for the treatment of cryptosporidiosis in non-immunodeficient children and adults, and is considered a highly effective treatment option 6.