Friday, September 22, 2017

Q: Which of the following can be used in the treatment of severe diarrhea in immunocompromised host secondary to Cryptosporidium except

A) Nitazoxanide
B) Paromomycin
C) Azithromycin 
D) Clarithromycin 

Answer: D

Debilitating diarrhea secondary to Cryptosporidium   is a significant problem in immunocompromised hosts. Though supportive treatment, reduction of immunosuppression or restoration of the immune system are the mainstay of treatment. But, in life-threatening diarrhea usually nitazoxanide or paromomycin in combination with  azithromycin can be used. Interestingly, azithromycin though effective as a treatment but is not effective as a prophylaxis. On the other hand, clarithromycin or rifabutin may be protective, but not useful as a treatment.


1.  Legrand F, Grenouillet F, Larosa F, et al. Diagnosis and treatment of digestive cryptosporidiosis in allogeneic haematopoietic stem cell transplant recipients: a prospective single centre study. Bone Marrow Transplant 2011; 46:858. 

2.  Palmieri F, Cicalini S, Froio N, et al. Pulmonary cryptosporidiosis in an AIDS patient: successful treatment with paromomycin plus azithromycin. Int J STD AIDS 2005; 16:515. 

3. Rossignol JF. Nitazoxanide in the treatment of acquired immune deficiency syndrome-related cryptosporidiosis: results of the United States compassionate use program in 365 patients. Aliment Pharmacol Ther 2006; 24:887. 

4. Holmberg SD, Moorman AC, Von Bargen JC, et al. Possible effectiveness of clarithromycin and rifabutin for cryptosporidiosis chemoprophylaxis in HIV disease. HIV Outpatient Study (HOPS) Investigators. JAMA 1998; 279:384.

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