Treatment and Monitoring

There is no antimicrobial available that is effective at consistently eradicating Cryptosporidium, particularly in immunocompromised hosts. In general, immunocompetent persons and those with asymptomatic infection do not require antimicrobial therapy. In patients with HIV/AIDS, the optimal therapy is restoration of immune function through the use of antiretroviral therapy (ART). In persons in whom antimicrobial therapy is deemed necessary or in HIV/AIDS patients in whom ART is ineffective, a combination of an antimicrobial and an antidiarrheal agent is recommended. Azith-romycin and clarithromycin have shown some treatment success for cryptosporidios-is, even in HIV-positive patients.36 However, the most promising agent is nitazoxan-ide, which is approved by the FDA for the treatment of cryptosporidiosis in adults and children. In randomized, placebo-controlled trials, nitazoxanide has demonstrated efficacy in cryptosporidiosis in immunocompetent persons, malnourished children, and

3 37

HIV/AIDS patients with CD4+ cell counts above 50 cells/mm . Limited evidence suggests that patients with CD4+ cell counts of less than 50 cells/mm may benefit

from higher doses, longer durations, or both.

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