Enterocytozoan bienusi and Encephalitozoon intestinales Microsporidiosis

This organism's clinical presentation is similar to that of cryptosporidium and isospora. In immunocompetent patients, the diarrheal illness is usually self-limited. In immunocompromised persons, particularly AIDS patients with CD4 < 100/mm3, it is a common cause of chronic diarrhea and can be remitting over months. Treatment depends on the species identified. For Encephalitozoon intestinales, the preferred regimen is albendazole 400 mg orally 2 times daily for at least 3 weeks; alternatively, metronidazole 500 mg orally three times daily has variable efficacy. Only recently, a small study among immunocom-prised patients identified an effective treatment for Enterocytozoan bieneusi: fumagillin 60 mg/d for 14 days (Molina et al, 2002). Fumagillin, however, is associated with high rates of neutropenia and thrombocytopenia. For AIDS patients, again immune reconstitution with antiretroviral therapy is often the best therapy.

TABLE 52-1. Drug Therapy for Intestinal Protozoan Parasites

Parasite

Drug

Adult Dosage

Pediatric Dosage

Availability/Comments

Balantidium coli (Balantidiasis)

Drug(s) of choice

Tetracycline

500 mg qid x 10 d

40 mg/kg/d (max 2 g) in 4 doses x 10 d

Alternative

Metronidazole

750 mg tid x 5 d

35 to 50 mg/kg/d in 3 doses x 5 d

Or

lodinoquinol

650 mg tid after meals x 20 d

40 mg/kg/d (max 2 g) in 3 doses x 20 d

Blastocystis homini

Metronidazole

750 mg tid x 5 d

35 to 50 mg/kg/d in 3 doses x 5 d

Treatment controversial

Or

lodoquinol

650 mg tid x 20 d

30-40 mg/kg/d (max 2 g) in 3 doses

x 20 d

Cryptosporidium parvum (cryptosporidiosis)

Immunocompetent

Nitazoxanide

500 mg bid x 3d

200 mg bid (4-11 yr); 100 mg bid (1-

3 yr)

Consider no treatment

HIV-infected

Paromomycin

1 g bid x 4 wks then alone

And

Azithromycin

600 mg qd x 4 wks

Treat with HIV antiretrovirals as

most efficacious

Cyclospora cayetanensis

Drug(s) of choice

Trimethoprim-

160 mg TMP, 800 mg

TMP 5 mg/kg, SMX 25 mg/kg

1 DS po bid

sulfamethoxazole

SMX bid x 7-10 d

bid x 7-10 d

Dientamoeba fragilis

Drug(s) of choice

Iodoquinol

650 mg tid x 20 d

30^0 mg/kg/d (max 2 g) in 3 doses

x 20 d

Or

Paromomycin

25-35 mg/kg/d in 3 doses x 7 d

25-35 mg/kg/d in 3 doses x 7 d

Or

Tetracycline

500 mg qid x 10 d

40 mg/kg/d (max 2 g) in 4 doses x 10 d

Or

Metronidazole

500-750 mg tid x 10 d

20-40 mg/kg/d in 3 doses x 10 d

Entamoeba histolytica (Amebiasis)

Asymptomatic

Drug(s) of choice

Iodoquinol

650 mg tid after meals x 20 d

30-40 mg/kg/d (max 2 g) in 3 doses

x 20 d

Or

Paramomycin

25-35 mg/kg/d in 3 doses x 7 d

25-35 mg/kg/d in 3 doses x 7d

Alternative

Diloxanide furoate

500 mg tid x 10 d

20 mg/kg/d in 3 doses x 10 d

Not commercially available but

can be compounded by Medical

Center Pharmacy (203-688-6816)

or Panorama Compounding

Pharmacy (800-292-6773)

Mild to moderate intestinal disease

Drug(s) of choice

Metronidazole

500-750 mg tid x 7-10 d

35-50 mg/kg/d in 3 doses x 7-10 d

Or

Tinidazole

800 mg tid x 3 d

50 mg/kg (max 2 g) qd x 3 d

Not commercially available in

the US. As effective as

metronidazole and better

tolerated.

Plus

lodoquinol OR

Same as asymptomatic

Same as asymptomatic regimen

Paramomycin OR

regimen

Diloxanide furoate

Severe intestinal disease

Drug(s) of choice

Metronidazole

750 mg tid x 7-10 d

35-50 mg/kg/d in 3 doses x 7-10 d

Or

Tinidazole

800 mg tid x 5 d

35-50 mg/kg/d in 3 doses x 7-10 d

Plus

Iodoquinol OR

Same as asymptomatic

Same as asymptomatic regimen

Diloxanide furoate

regimen

If parenteral therapy needed

Metronidazole IV

0.5-1g IV q12h

7.5 mg/kg q6h > 28 days old

Luminal agent helps prevent

relapse/extraintestinal disease

Enterocytozoon bienusi(microsporidiosis)

Drug(s) of choice

Fumagillin

60 mg/d po x 14 d

Encephalitozoon [Septata] intestinalis (microsporidiosis)

Drug(s) of choice

Albendazole

400 mg bid x 21 d

Giardia lamblia (giardiasis)

Drug(s) of choice

Metronidazole

250 mg tid x 5 d OR 2 g qd x 3 d 15—30 mg/kg/d in 3 doses x 5 d

Alternatives

Albendazole

400 mg qd x 5 d

OR

Quinacrine

100 mg tid x 5d

2 mg/kg x 5 d (max 300 mg/d)

Not available commerically in

(maximum 300 mg/d)

the US, but can be compounded

OR

Tinidazole

2 g once

50 mg/kg once (max 2 g)

Not available commercially in US

OR

Furazolidone

100 mg qid x 7-10 d

6 mg/kg/d in 4 doses x 7-10 d

OR

Paramomycin

25-35 mg/kg/d in 3 doses x

25-35 mg/kd/d in 3 doses x 7 d

3 doses x 7 d

OR

Nitazoxanide

500 mg bid x 3 d

Isospora belli(Isosporiasis)

Drug(s) of choice

Trimethoprim-

160 mg TMP, 800 mg

TMP 5 mg/kd, SMX 25 mg/kg bid x

10 d

1 DS po bid

sulfamethoxazole

SMX bid x10 d

Adapted from The Medical Letter on Drugs and Therapeutics, 2002; Gilbert et al, 2003; Goldsmith, 2003 .

bid = twice daily; HIV = human immunodeficiency virus; IV = intravenous; max = maximum; po = by mouth; qd = every day; qid = 4 times daily; q6h = every 6 hours; q12h = every 12 hours; SMX = sulfamethoxazole; tid = 3 times daily; TMP = trimethoprim.

Adapted from The Medical Letter on Drugs and Therapeutics, 2002; Gilbert et al, 2003; Goldsmith, 2003 .

bid = twice daily; HIV = human immunodeficiency virus; IV = intravenous; max = maximum; po = by mouth; qd = every day; qid = 4 times daily; q6h = every 6 hours; q12h = every 12 hours; SMX = sulfamethoxazole; tid = 3 times daily; TMP = trimethoprim.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

Get My Free Ebook


Post a comment