Treatment

Therapies for the patients with diarrheal diseases can be divided into antimicrobial therapies, and therapies for the associated diarrhea, dehydration, and malnutrition. There is no known effective therapy for cryptosporidiosis. Many agents have been tried, and the results have been disappointing. Some patients improved during treatment with paromomycin (Humatin, Parke Davis, Ann Arbor, MI), whereas controlled trials showed only modest improvement and no cures. An uncontrolled trial of paromomycin plus azithromycin showed good response in terms of clinical symptoms and oocyst excretion. Clarithromycin or rifabutin prophylaxis for MAC prophylaxis may reduce risk of cryptosporidiosis. Overall, HAART with immune reconstitution is the only consistently effective treatment for cryptosporidiosis (Miao et al, 2000).

Few studies of drug treatment of Enterocytozoon bieneusi infection have been published. Albendazole (GlaxoSmith-Kline) is ineffective as treatment, but is effective therapy for E. intestinalis infection. Anecdotal success in the treatment of E. intestinalis has been reported with itraconazole, fluconazole, atovaquone, and metronidazole. Experimental drugs include Fumagillin, TNP-470, and Ovalicin. HAART with immune reconstitution is best therapy, especially for the 80 to 90% of cases involving E. bieneusi.

Isosporiasis may be treated with trimethoprim sulfa. Due to a high rate of recurrence, repeated courses or chronic maintenance with trimethoprim may be needed. Some have advocated treatment indefinitely unless there is immune recovery. The optimal duration of high dose therapy is not well defined. There has been one case report of refractory infection that responded to pyrimethamine plus sulfadiazine.

CMV colitis appears to occur less often in subjects taking protease inhibitors and also has a lower rate of recurrence in subjects on HAART. Survival outcomes are also significantly better in patients with CMV colitis who are on HAART. Two agents are clinically effective in the treatment of CMV colitis. The most widely used is ganciclovir. Ganciclovir therapy also has been associated with nutritional repletion and with prolonged survival. Oral ganci-clovir is available for maintenance therapy. Other analogues with better bioavailability have been developed. Foscarnet has activity against CMV as well as HIV.

Several drugs have in vitro efficacy against MAC including the macrolide clarithromycin (Biaxin), ethambutal (Myambutal), rifabutin (Mycobutin), and clofazamine (Lamprene). Other drugs with in vivo or in vitro efficacy include amikacin, ciprofloxacin, cycloserine, and ethion-amide. Three drugs, azythromycin, rifabutin and clar-ithromycin, have been shown to be effective prophylactic agents. In the setting of immune reconstitution, primary prophylaxis may be discontinued when the CD4 count increases to > 100/mm3 for > 3 months. It appears that secondary prophylaxis (prior disseminated MAC) may also be discontinued when the CD4 count is > 100 plus HAART for 6 to 12 months.

The treatment of enterocolitis due to Salmonella, Shigella,or Campylopbacter sp is modified in that IV with antibiotics is used commonly, due to the frequent occurrence of bacteremia. In addition, repeated or chronic courses of antibiotics such as trimethoprim sulfa or ciprofloxacin often are needed because of disease recurrence. Treatment of chronic bacterial enteropathy with broad spectrum antibiotics has brought clinical improvement in several patients. The difficulty in choosing antibiotics is the inability to determine which bacteria in stool are the offending organisms. In addition, the widespread use of antibiotics could lead to the development of mul-tidrug resistance strains.

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.

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