Combination drug therapy for cryptosporidiosis

Aside from effective antiretroviral therapy, there is no consistently effective antiparasitic therapy for cryptosporidiosis in AIDS. The purpose of this study was to assess safety, efficacy, and durability of combination therapy with paromomycin and azithromycin for chronic cryptosporidiosis. Patients with AIDS, chronic cryptosporidiosis, and100 CD4 cells/mL were treated with open-label paromo-mycin (1.0 g twice a day) plus azithromycin (600 mg once a day) for 4 weeks, followed by paromomy-cin alone for 8 weeks. In 11 patients, median stool frequency decreased from 6.5/day (baseline) to 4.9/day (week 4) and 3.0/day (week 12). Median reductions in 24-h oocyst excretion were 84%, 95%, and99 % at 2, 4, and 12 weeks, respectively. None of the responses were attributable to antiretrovi-rals. Of 5 survivors at 12–30 months of follow-up, 3 remain asymptomatic off medications, and 2 have chronic, mild diarrhea. Treatment of cryptosporidiosis with azithromycin and paromomycin was associated with significant reduction in oocyst excretion and some clinical improvement. Cryptosporidium parvum, an intracellular protozoan parasite, AIDS-related cryptosporidiosis, azithromycin monotherapy has been ineffective [7, 8]. In clinical practice, azithromycin hasis a frequent cause of chronic diarrhea in human immunodefi-ciency virus (HIV)–infected patients, resulting in significant frequently been used in combination with paromomycin for treatment of cryptosporidiosis [9], but the safety and efficacymorbidity and mortality. Chronic cryptosporidiosis occurs whe