Treatment of Cryptosporidium species infection in patients with immune compromise

For patients with significant immune compromise (eg advanced HIV infection, solid organ or bone marrow transplant recipients, hypogammaglobulinaemia, immunoglobulin A [IgA] deficiency), infection with Cryptosporidium species (cryptosporidiosis) may be prolonged or severe. It responds best to an improvement in the patient’s immune status.

In patients with HIV infection, antiretroviral therapy with immune reconstitution reduces the duration and severity of gastroenteritis. For patients with a new diagnosis of HIV, see Cryptosporidium species gastroenteritis in adults with HIV infection for information on starting antiretroviral therapy.

There is limited evidence supporting the use of antimicrobials to treat cryptosporidiosis in patients with immune compromiseLa Hoz, 2019. Rehydration and antidiarrhoeal drugs are the mainstay of treatment (see Approach to managing acute gastroenteritis).

In addition to addressing the underlying cause of immune compromise (where possible), consider antimicrobial therapy in patients with severe diarrhoea caused by Cryptosporidium species or those with symptoms not improving after 2 weeks; useLa Hoz, 2019:

nitazoxanide orally, 12-hourly for 14 days1 nitazoxanide nitazoxanide nitazoxanide

adult or child 12 years or older: 500 mg. For dosage adjustment in adults with kidney impairment, see nitazoxanide dosage adjustment

child 1 to 3 years: 100 mg2

child 4 to 11 years: 200 mg3.

1 Nitazoxanide is not registered for use in Australia but is available via the Special Access Scheme.Return
2 This dose applies to the oral suspension; the film-coated tablet formulation is not bioequivalent.Return
3 This dose applies to the oral suspension or dispersible tablet; the film-coated tablet formulation is not bioequivalent.Return